肝异位脾脏五例诊治体会  

Experience in the management of hepatic splenosis:5 cases

作　　者：龙新[1] 张磊[1] 赵健萍 程琪[1] 朱鹏[1] 张必翔[1] 陈孝平[1] LONG Xin;ZHANG Lei;ZHAO Jianping(Hepatic Surgery Center.Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Key Laboratory of Hepato Pancreato Biliary diseases,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心/肝胆胰疾病湖北省重点实验室,武汉430030

出　　处：《临床外科杂志》2020年第6期554-556,共3页Journal of Clinical Surgery

基　　金：国家自然基金青年基金资助项目(81803175);湖北陈孝平科技发展基金会资助项目(CXPJJH11900001-2019345)。

摘　　要：目的总结5例肝异位脾脏病人临床特点,以提高该病的诊断准确率。方法我院2013~2018年经病理检查证实为肝异位脾脏5例,对其年龄、性别、症状、体征、实验室及影像学检查、手术情况、病理及其随访进行总结分析。结果所有病人均为男性,身体状况良好,年龄33~52岁,平均年龄45岁,均有外伤脾切除史,平均时隔16.4年。腹部可见陈旧性手术瘢痕。肝功能Child分级A级,肿瘤标志物正常。病灶超声检查显示为低回声或不均匀回声,边界清楚;CT检查表现为低密度,动脉期强化,延迟期不均匀强化;MRI检查表现为长T1长T2信号,灌注与增强CT类似,DWI见轻度弥散受限或无变化。所有病人均接受手术探查,包括4例腹腔镜手术,术中发现6个病灶,分布于肝2、4、6、8段,直径1.5~5 cm。手术切缘足够,平均手术时间186分钟,平均失血量100 ml。所有病人未输血,未阻断肝门,肿块未破裂。术后恢复顺利,术后住院时间5~9天。切除病灶病理证实为脾组织。术后随访均未见复发。结论外伤性脾破裂或脾切除病史有助于肝异位脾脏的诊断,对于不确定病灶腹腔镜探查是有效的处理措施。Objective To summarize five cases of hepatic splenosisin to improve diagnostic accuracy.Methods Five hepatic splenosis cases confirmed by pathology from 2013 to 2018 were collected in our hospital.Clinical characteristics including age,gender,past history,physical examination,liver function as well as tumor markers,imaging,surgical findings,pathological examination and follow-ups were analyzed.Results All the patients with good performance status were male,aging from 33 to 52 years,average 45 years.All of them experienced trauma and splenectomy,time interval of which was 16.4 years on average,and left surgical scars on abdomen.Child-Pugh was grading as A.No abnormality was found for tumor markers.Ultrasonography showed hypo or iso-echoic lesion with clear boundaries.The lesions were presented as hypodensity mass in plain CT scan,enhanced in arterial phase and decreased to iso-density in delayed phase for contrast-enhanced CT.MRI displayed long T1 and long T2,slight hyper-intensity or unchanged in DWI.PWI was similar to that of CT.The patients underwent surgical treatments,four of them received laparoscopic partial hepatectomy with sufficient surgical margin.Six lesions with intact capsules were discovered in segment 2,4,6 and 8,ranging from 1.5 to 5 cm in diameter.Average operation time was 186 minutes,and blood loss was 100 ml.No transfusion,lesion rupture and hepatic blood occlusion appeared.The patients discharged uneventfully,5 to 9 days after surgery.All tumors were identified as spleen tissues by histology examination.No recurrence was found during the follow-ups.Conclusion History of splenic trauma or splenectomy is helpful for the diagnosis of hepatic splenosis.Laparoscopic exploration is recommended for uncertain cases.

关 键 词：肝异位脾脏 肝部分切除 

分 类 号：R657.3[医药卫生—外科学]