论文部分内容阅读
病例 男,48岁,近4月渐觉腹围增大不适,且逐加重。查体:一般情况可,浅表淋巴结不肿大;腹部膨隆,肝、脾未满意扪及,腹水征(+);直肠指检(-),腹穿:抽出淡黄色胶冻状腹水。大便隐血(+),小便(-)。腹水常规:蛋白定性+++,RBC+++,WBC 0～6,间皮细胞0～2。肝、肾功能正常,甲胎球蛋白(-)。胃镜检查未见异常。B超检查示肝、脾正常,胰前左中腹见20cm×5.6cm中等强光回声区,回声不均,界清欠规则,腹腔大片液性暗区中可见密集点状回声,提示:(1)腹水,(2)腹腔内肿瘤。CT检查示腹腔大量积液,大网膜及肠系膜根部散在多个直径约3cm之低密度结节,彼此融合成团,界清面广,提示:(1)腹水,(2)大网膜、肠系膜肿瘤。术前准备:术前2日利尿,术前一日用16号针在左、右下腹抽出胶冻样腹水共5000ml。手术所见:腹腔胶冻样腹水约4500ml,内有大小不等、葡萄胎样小肿物悬浮,部分成团,部分粘附在腹膜和小肠壁上形成颗粒状肿
The case was male, 48 years old. In the past 4 months, the abdominal circumference became more and more uncomfortable and heavier. Physical examination: In general, superficial lymph nodes are not enlarged; abdominal distention, liver and spleen are not satisfactory, ascites sign (+); rectal examination (-), abdominal dissection: light yellow jelly-like ascites. Fecal occult blood (+), urine (-). Ascites routine: protein qualitative +++, RBC+++, WBC 0-6, mesothelial cells 0-2. Normal liver and kidney function, alpha fetuin (-). No abnormal gastroscopy. B-ultrasound showed that the liver and spleen were normal, and 20cm x 5.6cm medium-strong light echo area was found in the left middle belly of the pancreas. The echoes were uneven, the borders were clear, and dense punctate echoes were seen in the large dark areas of the abdominal cavity. Ascites, (2) Intra-abdominal tumors. CT examination showed a large amount of effusion in the abdominal cavity. The roots of the greater omentum and mesentery were scattered with multiple low-density nodules about 3 cm in diameter, and they merged into a group. The boundary was clear and wide, suggesting: (1) ascites, (2) omentum, Mesenteric tumors. Preoperative preparation: diuresis on the 2nd day before surgery, and a total of 5000 ml of jelly-like ascites was withdrawn on the left and right lower abdomen on the day before surgery with a 16-gauge needle. Surgical findings: Abdominal jelly-like ascites of about 4500ml, with varying sizes, small tumours of hydatidiform mole suspended, partially clumped, partially adherent to the peritoneum and small intestine walls to form a granular swelling