2021年 · 第59卷第01期

Today, we celebrate the 70th birthday of the Chinese Journal of Surgery.

Male, 60 years old, was admitted to the Department of Gastroenterology of our hospital on June 24, 2020 due to "repeated epigastric pain for 8 months, aggravated for 2 days". Eight months ago, the patient was diagnosed with "acute pancreatitis" in another hospital due to upper abdominal pain and elevated blood amylase after overeating, and improved after symptomatic treatment. In the past 8 months, the epigastric pain was repeated, with a mild degree. All of them improved after self-analgesic treatment, and no medical treatment was sought. Two days before admission, there was no obvious trigger for abdominal pain to aggravate, and he was admitted to the hospital with "acute pancreatitis" in the emergency department of our hospital. He was given symptomatic supportive treatment again, and improved after one week. Gastroscopy performed on 3 Jul 2020 revealed duodenal papillary occupancy and biopsy revealed goblet cell adenocarcinoma. The results of enhanced CT examination showed that the duodenal papillary arterial phase enhanced nodules, with a maximum diameter of about 2 cm, exudated around the pancreatic head and uncinate process (FIG. 1A）。 On July 19, 2020, he was transferred to our department for further treatment. The patient had no previous history of hypertension, diabetes, trauma and surgery; Not smoking, occasional drinking; There is no tumor family genetic history. The diet has been reduced by 50% in the past 1 month, and the body weight has been reduced by 3 kg. Physical examination: height 182 cm, weight 82 kg, body mass index 24.8 kg/m²。 There was no yellowing stain on the skin and sclera, abdominal distension, no tenderness, rebound pain, no mass, abdominal knocking and drumming sound, and normal intestinal sound. When transferred to our department, liver and kidney function and electrolytes were normal, albumin was normal, blood and urine amylase was normal, and tumor markers (CA19-9, carcinoembryonic antigen, alpha-fetoprotein, CA125, CA242) were all normal.

Male, 45 years old, was admitted to the hospital on May 10, 2017 due to "discomfort in right upper abdomen for 1 month". One month ago, the patient had right upper abdominal discomfort without obvious trigger, which was dull and tolerable, without radiating pain in shoulder and back, without nausea, vomiting, diarrhea and other discomfort. Local hospital laboratory test results: alpha-fetoprotein 462.0 μ g/L, normal liver function; The results of abdominal enhanced CT examination showed that the space-occupying lesions in 6 segments of the liver, with a maximum diameter of 0.8 cm, were considered as liver cancer. Interventional embolization for liver cancer was performed in a local hospital on 12 April 2017. Has a history of hepatitis B for 10 years, and has been given oral tenofovir antiviral therapy since 2015; Previous history of type 2 diabetes for 8 years, subcutaneous injection of insulin aspart to control blood sugar; Deny history of hypertension, coronary heart disease, etc. Physical examination after admission: vital signs were stable, liver palm was visible, no spider nevus was seen, and there was no tenderness and rebound pain in the whole abdomen. Laboratory test: alpha-fetoprotein 537.0 μ g/L, normal liver function. The results of enhanced CT examination of the abdomen showed that the residual activity of the 6 segments of the liver was increased, and the size was about 1.6 cm ×1.2 cm (Figure 1）。

Male, 53 years old, was admitted to hospital on March 13, 2016 due to "abdominal pain for more than 1 month, and liver was found to occupy space for 1 week". Physical examination showed no obvious positive signs. The patient had a history of hepatitis B for more than 2 years and was not treated with antiviral drugs. Tumor markers examination: alpha-fetoprotein and carcinoembryonic antigen were in the normal range, and CA19-9 was 38.8 kU/L; The Child-Pugh grade of liver function was A, positive for hepatitis B surface antigen, hepatitis B e antibody and hepatitis B core antibody, and the viral DNA quantification was 4.81×10⁴U/ml. CT results showed that the size of the right posterior lobe of the liver was about 5.4 cm ×5.0 cm low-density shadow, which showed irregular progressive enhancement in the enhancement phase, and slight dilatation of the bile duct was seen inside. Considering the possibility of cholangiocarcinoma, the right hepatic pedicle was suspected to be invaded. Preliminary diagnosis: (1) liver occupation, cholangiocarcinoma (stage II); (2) Post-hepatitis B cirrhosis.

Male, 65 years old, was admitted to hospital on October 8, 2018 due to "right upper abdominal pain for more than 10 days, and found that the right liver occupied a huge space". The patient had moderate pain in the right upper abdomen without obvious trigger more than 10 days ago, which was persistent, without fever, nausea and vomiting. Ultrasound examination in other hospitals showed that the right lobe of the liver occupied a huge solid mass, which was considered as massive liver cancer. In the past, he denied the history of hypertension, diabetes, hepatitis, tuberculosis, etc., and denied the history of drug and food allergies. Physical examination at admission: the abdomen was flat and soft, with palpable liver enlargement under the costal margin of the right upper abdomen, the lower margin was located 4 cm below the costs, and mild percussion pain in the liver area. Alpha-fetoprotein 56.05 μ g/L, carcinoembryonic antigen 5.89 μ g/L. ALT 85 U/L, AST 83 U/L, Bilirubin normal. Hepatitis B surface antigen and hepatitis C antibody were negative. An enhanced CT scan of the abdomen revealed a huge solid mass in the 5th and 8th segments of the liver, approximately 11.3 cm ×7.2 cm ×8.7 cm in size, which was considered as hepatocellular carcinoma, and no metastatic nodules were seen around it (Figure 1）。 PET-CT showed that the right liver occupied a huge space, which was considered as a malignant tumor. No metastasis was found in the rest of the liver, abdominal cavity and whole body. The 15 min retention rate of indocyanine green was 13.4%.