儿童脾脏肿瘤的临床特点及预后分析  

Clinical characteristics and outcomes of splenic tumor in children

作　　者：刘登辉[1] 李勇[1] 肖雅玲[1] 尹强[2] 黎明[1] 唐湘莲[1] 周宇翔[1] 黄召[1] Liu Denghui;Li Yong;Xiao Yaling;Yin Qiang;Li Ming;Tang Xianglian;Zhou Yuxiang;Huang Zhao(DepartmentⅡof General Surgery,Children's Hospital of Hunan Province,Changsha 410007,China;DepartmentⅠof General Surgery,Children's Hospital of Hunan Province,Changsha 410007,China)

机构地区：[1]湖南省儿童医院普外二科,湖南省长沙市410007 [2]湖南省儿童医院普外一科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2020年第8期705-710,共6页Journal of Clinical Pediatric Surgery

基　　金：湖南省自然科学基金(编号:2018JJ2210)。

摘　　要：目的探讨儿童脾脏肿瘤的临床特点、治疗策略及预后。方法回顾性分析湖南省儿童医院普外科2010年1月至2019年12月收治的24例脾脏肿瘤患儿的临床资料,其中男童14例,女童10例;中位年龄7岁2个月。结果24例中良性肿瘤20例,恶性肿瘤4例。20例良性肿瘤中行脾脏切除及大网膜自体脾片移植术4例,行腹腔镜下脾脏部分切除术8例,行开腹脾脏切除术4例,行脾脏囊肿开窗引流+囊肿去顶毁底术1例,脾脏血管瘤行介入栓塞治疗3例;4例脾脏恶性肿瘤均行手术和化疗治疗,手术方式为脾脏切除、转移病灶切除联合脾门淋巴结清扫及输液港植入(3例)以备术后化疗。脾脏良性肿瘤随访至今预后良好;脾脏恶性肿瘤随访时间最长至2019年6月(1例患儿已存活6年),3例存活,除1例术后5个月内复发死亡以外,其他患儿未出现术后复发、血管栓塞、脾脏切除术后凶险性感染(over-whelming post splenectomy infection,OPSI)等情况。结论儿童脾脏良性肿瘤治疗方式以腹腔镜手术为主,或脾脏切除联合大网膜自体脾片移植以保留脾脏自身免疫功能;脾脏恶性肿瘤则行开腹根治性手术及化疗。良性肿瘤预后良好,而恶性肿瘤预后相对较差,早诊断、根治手术及辅助放化疗的综合治疗是改善脾脏恶性肿瘤预后的重要手段。Objective To explore the clinical features,treatment strategies and outcomes of children with splenic tumor.Methods From January 2010 to December 2019,clinical data were retrospectively analyzed for 24 children of splenic tumor.There were 14 boys and 10 girls with a median age of 7.2 years.Results The tumors were benign(n=20)and malignant(n=4).Benign tumors were managed by splenectomy&autologous splenic slice transplantation(n=4),laparoscopic partial splenectomy(n=8),open splenectomy(n=4),splenic cyst drainage&cyst top-to-bottom destruction(n=1)and interventional therapy for splenic hemangioma(n=3).Malignant tumors were removed by splenectomy,removal of metastatic lesions and splenic hilum lymph node dissection,with implantable venous infusion port for adjuvant chemotherapy.During follow-ups,benign tumors patients had an excellent recovery.For primary malignant tumors(n=3),the longest 6-year follow-up was until June 2019 and three cases survived.One child died at Month 5 post-operation.Other children showed no recurrence of splenic tumor,vascular embolism or over-helming postsplenectomy infection.Conclusion Laparoscopic splenectomy is a major option for benign splenic tumors in children.Spleen is an important organ of immune system in children,benign splenic tumors should be managed by partial splenectomy or splenectomy plus splenic omentum autologous splenic slice transplantation.However,malignant splenic tumors are better treated by radical laparotomy and chemotherapy.Benign splenic tumors have a better prognosis while the outcomes of malignant ones are poor.Earlier diagnosed,radical operation and chemotherapy improve outcomes for primary splenic malignant tumors.

关 键 词：脾肿瘤/外科学 治疗结果 儿童 

分 类 号：R567.6[医药卫生—呼吸系统] R733.2[医药卫生—内科学]