摘要
目的探讨伴有并存疾病的脾脏占位性病变的诊断和治疗。方法回顾性分析2002年1月至2012年6月江阴市人民医院收治的5例和无锡市人民医院收治的9例伴有并存疾病的脾脏占位性病变患者的临床资料。术前行B超和CT检查，根据患者术前影像学检查结果施行脾切除术或联合器官切除术。术后根据病理检查结果选择化疗方案。采用门诊和电话随访至2013年6月。结果脾脏占位性病变多无特异性症状，其中以左季肋区不适、胀痛为首发症状的4例，其余10例患者均无症状。患者术前诊断符合率为10／14，其中并存疾病为恶性肿瘤的患者术前诊断符合率为2／5。术前B超检查14例，明确诊断9例。CT检查9例，明确诊断7例。14例患者中，右侧卵巢癌、双侧卵巢癌与乙状结肠癌患者均与术后孤立性脾转移相关；其他11例患者的并存疾病与脾脏占位性病变不相关。合并左半结肠癌及2型糖尿病的脾脉管瘤患者、合并肾癌的脾硬化性血管瘤样转化患者和合并高血压及胆囊结石的脾淋巴管瘤患者的并存疾病和脾脏占位性病变为同期发现。其余11例患者的并存疾病与脾脏占位性病变为先后发现。14例患者中行单纯脾切除10例，行脾切除联合其他脏器切除4例。5例经病理检查明确的脾脏恶性占位性病变患者术后根据并存疾病选择化疗方案进行治疗。患者术后恢复均顺利，无全身凶险性感染发生。14例患者中，2例脾肉瘤患者分别于术后半年和1年出现全身转移；合并右侧卵巢癌的孤立性脾转移患者随访3年出现横结肠转移；合并双侧卵巢癌的孤立性脾转移患者随访2年出现腹腔广泛转移；合并乙状结肠癌的孤立性脾转移患者，术后4年死于腹腔肿瘤复发；合并左半结肠癌、2型糖尿病的脾脉管瘤患者因左半结肠癌分期早，随访6年仍生存。其余9例并存疾病为良性疾病的患者随访时间内均生存。结论伴有并存疾病的脾脏占位性病变的患者依靠术前影像学和术后病理检查确诊，在排除绝对手术禁忌证后采取外科治疗安全可靠，预后由并存疾病的进展和脾脏占位性病变的肿瘤性质共同决定。
Objective To investigate the diagnosis and treatment of splenic space occupying lesions associated with comorbidity. Methods The clinical data of 5 patients from Jiangyin People＇s Hospital and 9 patients from Wuxi People＇s Hospital from January 2002 to June 2012 were retrospectively analyzed. All the patients suffered from splenic space occupying lesions associated with comorbidity. Splenectomy or multi-visceral resection were selected according to the results of preoperative B sonography and computed tomography examination. Chemotherapy regimes were selected based on postoperative pathological exami- nation. All the patients were followed up till June 2013. Results The symptoms of patients with splenic space occupying lesions were non-specific. The first symptoms of 4 patients were discom- fort or distending pain of left upper abdomen, and the other 10 patients had no symptoms. The coincidence rate of preoperative diagnosis was 10/14, and the coincidence rate of preoperative diagnosis for patients with malignant tumors was 2/5. Fourteen patients received preoperative B uhra-sonography, and 9 were definitively diagnosed. Nine patients received computed tomo- graphy, and 7 were definitively diagnosed. Of the 14 patients, right ovarian cancer, bilateral ovarian cancer and sigmoid colon cancer were correlated with solitary splenic metastasis, and the main lesions of the other 11 patients were not correlated with splenic space occupying lesions. The main lesions of patients with left colon carcinoma, type 2 diabetes and vascular tumor of the spleen, patients with renal carcinoma and splenic sclerosing hemangioma, and patients with hypertension, cholecystolithiasis and splenic lymphangioma were diagnosed simultaneously with the splenic space occupying lesions, and the main lesions of the other 11 patients were diagnosed separately with the splenic space occupying lesions. Ten patients underwent simple splenec- tomy and 4 patients received multi-visceral resection. Chemo- therapy regimens were selected according to the type of main lesions for 5 patients who were diagnosed by pathological exami- nations. All the patients were recovered smoothly with no occur- rence of severe infections. Two patients with splenic sarcoma had tumor metastasis at postoperative 6 months and 1 year, respec- tively. One patient with right ovarian cancer and solitary splenic metastasis had transverse colonic metastasis at postoperative 3 years. One patient with bilateral ovarian cancer and solitary splenic metastasis had peritoneal metastasis at postoperative 2 years. One patient with sigmoid colon cancer and solita~）T splenic metastasis died of peritoneal htmor reeurrenee at post- operative 4 years. One palienl with left cohul carcinoma, type 2 diabetes and vascular tumor of the spleen survived for 6 years and was still s^und and well. The other 9 patients with benign disease survived ~,ithin the period of follow-up. Conclusions The definitive diagnosis tbr patients with splenic spaee occupying disease associated ~ith eomorl,idity depends on the preoperative imaging examination and posloperative pathological examinalion. Surgical treatment is safe when operative contraindications are excluded. The prognosis of patients is determined by the progress of main lesions and the character of splenic spaee occupying lesions.
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2013年第9期708-710,共3页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金（81101801/H1617）
江苏省自然科学基金（BK2010160）
无锡市卫生局指导性课题（ZD1006）
关键词
脾脏占位性病变
诊断
治疗
Splenic space occupying lesions
Diagno-sis
Treatment
