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男性，64岁。无痛性进行性黄疸1个月，体重减轻。检查：巩膜黄染，血清总胆红素为70μmol/L，Courvoisier。征阴性。诊断首先要考虑（）
A . 下段胆管癌
B . 胆囊结石
C . 肝门部胆管癌
D . 胰头癌
E . 缩窄性乳头炎
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