儿童脾脏淋巴管瘤七例并文献复习  

Splenic lymphangioma in children:a report of seven cases with a literature review

作　　者：刘登辉[1] 李勇[1] 唐湘莲[1] 黎明[1] 肖雅玲[1] Liu Denghui;Li Yong;Tang Xianglian;Li Ming;Xiao Yaling(Department of General Surgery,Hunan Children′s Hospital,Hunan Changsha 410008,China)

机构地区：[1]湖南省儿童医院普外科,湖南长沙410007

出　　处：《腹部外科》2021年第3期223-227,243,共6页Journal of Abdominal Surgery

基　　金：湖南省卫生健康委科研课题(202104081314);湖南省儿童医院2020年度院级科研基金资助项目;湖南省自然科学基金-面上项目(2018JJ2210)。

摘　　要：目的探讨儿童脾脏淋巴管瘤(splenic lymphangioma,SLA)的临床特点、外科治疗策略及预后。方法回顾性分析2009年1月至2019年1月湖南省儿童医院普外科收治的7例SLA患儿临床资料;检索万方、维普、CNKI、PubMed、Embase、MedLine、Web of Science及Cochrane Library数据库截至2019年12月关于儿童SLA的相关文献,并进行分析。结果该中心7例SLA患儿中,男性5例,女性2例,中位年龄7岁5个月(3岁2个月~15岁)。体检发现脾脏占位病变者3例,有腹痛、呕吐等症状者4例;均行手术治疗,其中4例行开腹脾脏切除及大网膜自体脾片移植术,1例行3D腹腔镜下二级脾蒂离断脾上段切除术,1例行腹腔镜下脾中段切除术,1例因术中病理肿块性质不明,行开腹脾脏切除术。随访2~5年,无术后复发、血小板升高、免疫功能低下及脾切除术后凶险性感染等并发症。通过文献检索,纳入分析患儿29例,术前行B超、CT检查或正电子发射计算机断层显像-CT(PET-CT)检查脾脏有占位性病变,术后无复发及死亡。结论儿童SLA罕见,临床症状不典型,主要依靠影像学诊断,外科手术是最有效的治疗手段,应根据其肿瘤部位、大小和临床表现,选择合适的干预时间和手术方式,能取得较好的治疗效果及远期预后。Objective To explore the clinical characteristics,surgical strategies and outcomes of children with splenic lymphangioma(SLA).Methods Seven cases of children with splenic lymphangiomas were selected while more clinical cases retrieved from the databases of WanFang,Weipu,CNKI,PubMed,Embase,MedLine,Web of Science and Cochrane Library prior to December 2019.Results There were 5 boys and 2 girls with a median age of 7.4(3.2-15)years.Three cases of splenic space-occupying lesion were detected by examinations and 4 children of abdominal pain,vomiting and other symptoms underwent operations.The procedures included greater omentum implantation of autologous splenic segments after conventional splenectomy(n=4),two steps of splenic pedicle transection during three-dimensional laparoscopic upper splenectomy(n=1),two steps of splenic pedicle transection during laparoscopic middle splenectomy(n=1)and open splenectomy due to a unknown pathological diagnosis of mass(n=1).During a follow-up period of 2-5 years,there was no postoperative recurrence,elevated platelet count,low immune function or overwhelming post splenectomy infection(OPSI).Through literature searches,29 cases were included and analyzed.Before operation,B-ultrasound and CT/PET-CT were performed to confirm splenic space-occupying lesions.After operation,there was no death or recurrence.Conclusion SLA in children is rare and its clinical symptoms are often non-typical.A definite diagnosis is dependent upon imaging studies.Surgery is the most effective treatment.According to the location,size and clinical manifestations of tumor,appropriate intervention time and surgical approach should be selected to achieve better treatment efficacy and long-term prognosis.

关 键 词：儿童 脾脏 淋巴管瘤 临床特点 外科手术 预后 

分 类 号：R733.2[医药卫生—肿瘤]