胃肠肿瘤伴发的脾脓肿4例临床分析与文献复习  

Clinical analysis of 4 cases of splenic abscess secondary to gastrointestinal tumor and literature review

作　　者：岳巧艳[1] 朱丽莹[1] 黄金伟[2] 申玉英[1] YUE Qiaoyan;ZHU Liying;HUANG Jinwei;SHEN Yuying(Department of Infectious Diseases,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)感染性疾病科,南京210006 [2]温州医科大学附属第五医院感染性疾病科

出　　处：《中国感染与化疗杂志》2018年第4期377-382,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的讨论总结胃肠肿瘤伴发脾脓肿的临床表现及治疗,强调胃肠道肿瘤可继发脾脓肿,需引起临床医师重视。方法回顾2012年1月-2016年12月诊治的4例胃肠肿瘤伴发的脾脓肿患者的临床资料,分析其一般情况、基础疾病、临床表现、影像学特征、病原学特点、治疗方法和病情转归等,并进行文献复习,总结胃肠肿瘤伴脾脓肿患者的临床特点。结果4例胃肠肿瘤患者,其中2例胃腺癌、1例胃间质瘤以及1例结肠腺瘤;胃肠道肿瘤伴发的脾脓肿临床表现并无特异性,主要表现有发热、左上腹疼痛及白细胞总数升高,而影像学则表现为脾脏多发或单发的不规则低密度灶;2例病原菌为大肠埃希菌,其中1例患者为大肠埃希菌和屎肠球菌的混合感染,1例为粪肠球菌,另1例未明确病原菌。文献复习显示结肠脾曲的肿瘤可继发脾脓肿,此类患者以男性多见,病原菌多为大肠埃希菌。结论胃肠肿瘤因手术血运关系可能导致脾脓肿,应引起临床警惕。Objective To review the clinical characteristics and treatment of splenic abscess secondary to gastrointestinal tumor to improve the awareness of this complication.Methods The clinical data of splenic abscess were reviewed retrospectively in 4 patients with gastrointestinal tumor who were treated in our hospital during the period from January 2012 to December 2016,including demographic data,clinical manifestations,imaging features,microbial etiology,treatment,and patient outcomes.Similar case reports were retrieved from PubMed database for literature review.Results Four cases of splenic abscess were identified in patients with gastrointestinal tumor,including gastric cancer(2 cases)and one case each of gastric stromal tumor and colon adenoma.The splenic abscess secondary to gastrointestinal tumor did not show specific clinical manifestations.The major clinical manifestations included fever,left upper abdominal pain,and white blood cells increased.All the 4 patients had abnormal findings in imaging of spleen,manifested as multiple or single irregular low density lesions.The responsible pathogen was identified as Escherichia coli in 2 cases,including one cases of mixed infection caused by E.coli and Enterococcus faecium,Enterococcus faecalis was found in one case.The pathogen of the remaining one case was not clear.Literature review of similar cases indicated that splenic abscess was more easily secondary to the carcinoma of splenic flexure of colon.Conclusions Splenic abscess may be secondary to gastrointestinal neoplasms due to the change of blood flow after surgical operation.Clinicians should pay more attention to this complication.

关 键 词：脾脓肿 胃肠肿瘤 诊断 

分 类 号：R551.1[医药卫生—血液循环系统疾病]