胰腺内副脾九例误诊分析  

Misdiagnosed intrapancreatic accessory spleens, report of nine cases

作　　者：朱洪旭[1] 匡天涛[1] 戎叶飞[1] 倪晓凌[1] 周文涛[1] 楼文晖[1] 王单松[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中华普通外科杂志》2014年第9期666-669,共4页Chinese Journal of General Surgery

摘　　要：目的 回顾性分析胰腺内副脾误诊病例,总结其误诊原因,以期提高其诊断正确率.方法 收集复旦大学附属中山医院2005年4月至2013年12月间所有经病理证实为胰腺内副脾（IPAS）的病例,回顾性分析其临床资料,总结误诊的原因.结果 收治的10例IPAS中,仅有1例获得术前正确诊断,其余9例误诊为无功能性神经内分泌瘤5例、神经内分泌癌3例、胰腺导管腺癌1例.9例误诊的IPAS均无特异性的症状及体征,常规实验室指标大致正常.本组9例IPAS均位于胰尾处,平均直径为（1.3 ±0.2）cm（0.8 ～2.5 cm）,7例IPAS的CT及MRI强化方式均与脾脏高度相似,5例另见脾门周围副脾.结论 影像学检查对IPAS诊断具有重要意义.与脾脏类同的强化方式为其特征性的影像学表现,“肿物”直径＜2.5 cm及伴有脾门周围副脾时应高度警惕IPAS的可能.Objective To promote the diagnostic accuracy of intrapancreatic accessory spleen （IPAS）.Methods The clinical data of 10 cases of IPAS admitted in Fudan University Zhongshan Hospital from Apr 2005 to Dec 2013 were retrospectively analyzed.Results There were ten cases of IPAS confirmed pathologically.Only 1 of the ten cases was diagnosed correctly and definitely with IPAS preoperatively.The other 9 cases were misdiagnosed with benign or malignant pancreatic tumors,including nonfunctional neuroendocrine neoplasms in 5 cases,pancreatic neuroendocrine cancers in 3 and pancreatic intraductal adenocarcinoma in one.All the nine misdiagnosed patients has no specific symptoms or laboratory indexes.All the IPASs located in the tail of the pancreas with the mean diameter （1.3 ±0.2） cm（0.8-2.5 cm）.7 cases of IPAS show strikingly similar dynamic enhancement to the spleen on the CT scans and/or MRI.Accessory spleen around the splenic hilum was found in five cases.Conclusions Morphological study plays an important role in the diagnosis and IPAS carries parallel dynamic enhancement to the spleen on CT scans and/or MRI.IPAS should be considered as a differential diagnosis while the lesion is no more than 2.5 cm in diameter and when other accessory spleens were shown around the splenic hilum.

关 键 词：迷芽瘤 误诊 胰腺 脾 神经内分泌瘤 

分 类 号：R657.6[医药卫生—外科学]