脾脏肿瘤35例的临床诊治体会  

Management of splenic tumors:a report of 35 cases

作　　者：谭广[1] 于华龙 王忠裕[1] 殷朔[1] 

机构地区：[1]大连医科大学附属第一医院普通外科,辽宁大连116011 [2]庄河市中医医院普通外科,辽宁庄河116400

出　　处：《外科理论与实践》2007年第2期133-135,共3页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨原发性脾肿瘤和脾转移癌(metastatic carcinoma ofthe spleen,MCS)的临床诊断与治疗。方法:对35例经外科治疗并经病理证实的脾肿瘤的临床资料进行回顾性分析。结果:增强CT检查对术前良恶性肿瘤鉴别准确率为85．7％,B超误诊率达20％。34例行手术探查,33例行脾切除或部分睥切除。术后病理显示,21例属原发性恶性肿瘤,其中以恶性淋巴瘤最常见,占80．9％;恶性淋巴瘤术后化疗,1年存活率为90．5％(19/21),3年存活率52．4％(11/21),1例术后9年仍存活。原发性血管内皮肉瘤和脾纤维肉瘤合并肝转移者各1例,手术介入治疗术后分别存活13个月和18个月。11例原发性良性肿瘤以血管瘤和淋巴管瘤为多见,分别占45．5％和27．3％,本组脾转移癌3例占8．5％(3/35),分别为胃癌脾转移、结肠癌脾转移和卵巢癌脾转移;2例于术后半年内死亡,1例术后14个月死亡。结论:原发性肿瘤以手术治疗为主,恶性淋巴瘤常需辅助性化疗。良性肿瘤术后无须特殊处理,瘤体小者行部分脾切除。早期发现、早期治疗才能提高脾脏原发性恶性淋巴肿瘤的生存率,对于MCS采取加强l临床探查、结合影像学和病理检查可望提高检出率。Objective To discuss the diagnosis and treatment of primary and metastatic splenic tumors. Methods The clinical data of 35 patients with splenic tumor were retrospectively analyzed. Results B-type ultrasonography was performed in all patients and 20% of them were misdiagnosed. The accuracy of CT scanning for distinguishing benign and malignant tumors was 85.7%. Of 34 cases that underwent exploratory laparotomy, 33 were submitted to splenectomy or partial splenectomy. Pathological findings demonstrated that lymphoma was the leading malignancy, accounting for 80.9% of the primary malignant cases; the 1-year and 3-year survival rate of the patients receiving adjuvant chemotherapy were 90.5% （19/21） and 52.4%（11/21） respectively; one patient survived over 9 years. The survival time for one case of primary angiosarcoma and another of myofibroblastoma （both with liver metastatis, and underwent postoperative transarterial chemotherapy） were 13 and 18 months respectively. Lymphangioma and hemangioma were the leading benign tumors, accounting for 45.5% and 27.3% respectively. The primary lesions of 3 patients with metastatic splenic tumors were gastric carcinoma, colon adenocarcinoma and ovarian cancer respectively. Conclusions Surgical management is the main approach for the treatment of primary splenic tumors, and partial splenectomy is sufficient for small and benign splenic lesions. Adjuvant chemotherapy is necessary for splenic malignancies; early diagnosis and intervention are effective strategies to obtain better therapeutic results. Metastatic splenic tumors are infrequent, and comprehensive application of clinical exploration, imaging techniques and pathological examination is helpful to reach the accurate diagnosis.

关 键 词：脾切除术 脾脏肿瘤 诊断 

分 类 号：R733.2[医药卫生—肿瘤]