患者男，70岁。有肝炎病史20年。近 2个月来纳差，消瘦，肝区疼痛，査体:轻 度黄疸，面部有蜘蛛痣，腹膨隆，肝肋下 4cm可触及肿块，质硬，压痛，脾肋下 3cm，腹部移动性浊音阳性。应首先考 虑的诊断是

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