脾切除术后膈下种植脾1例  

Subphrenic splenic implantation after splenectomy:A case report

作　　者：李颖[1] 卢放根[1] 刘德良[1] 谭玉勇[1] 罗敏[1] 周雨迁[1] LI Ying;LU Fanggen;LIU Deliang;TAN Yuyong;LUO Min;ZHOU Yuqian(Department of Gastroenterology,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院消化内科,长沙410011

出　　处：《中南大学学报（医学版）》2020年第10期1266-1268,共3页Journal of Central South University ：Medical Science

摘　　要：膈下种植脾是临床罕见的疾病,多见于脾外伤或脾切除术后的患者,目前多采用外科手术进行诊断和治疗。中南大学湘雅二医院收治1例脾切除术后的46岁男性患者,入院时主诉为"腹痛、腹胀1年余"。超声内镜示胃底隆起,考虑起源于固有肌层的间质瘤可能性大。胃部增强CT示胃底部胃壁稍增厚。予抑酸、护胃治疗后,患者症状无好转。患者强烈要求在内镜下切除肿物,遂行经自然腔道内镜手术(natural orifice translumenal endoscopic surgery,NOTES)剥离膈下肿物,术后病理证实为种植脾。本例患者通过内镜下NOTES剥离膈下肿物,不仅明确了诊断,而且缓解了症状,使患者免于遭受二次外科手术伤害,对临床有一定借鉴意义。Subphrenic splenic implantation is a rare disease, usually occurred followed the splenic trauma and splenectomy. Surgeries are often necessary for diagnosing and treating it. A 46-year-old male post-splenectomy patient, tolerating abdominal bloating and pain for more than 1 year, was admitted to the Second Xiangya Hospital, Central South University.Fundus bulge suggested a possibility of stromal tumors originating from the muscularispropria layer with endoscopic ultrasound. Slightly stomachic thickness was detected using enhanced computed tomography(CT). Without any improvement for symptoms after medication, the patient strongly requested to undergo an endoscopic therapy. Natural orifice transluminal endoscopic surgery(NOTES) result confirmed it as subphrenic splenic implantation with postoperative pathology. In this case, NOTES helped us to confirm the diagnosis, relieve the symptoms, as well as prevent secondary surgery injury, which would be helpful to other clinicians.

关 键 词：脾切除术 膈下种植脾 内镜治疗 经自然腔道内镜手术 

分 类 号：R657.6[医药卫生—外科学]