腹腔镜手术治疗脾脏硬化性血管瘤样结节性转化的临床价值  

Clinical value of laparoscopic operation for the treatment of sclerosing angiomatoid nodular transformation of the spleen

作　　者：刘桂杰[1] 薄晓辉 叶静 雷晓锋 侯旭[1] 高超 LIU Gui-jie;BO Xiao-hui;YE Jing(Department of Hepatobiliary Surgery,Liaocheng People's Hospital and Liaocheng Affiliated Hospital of Shandong First Medical University,Liaocheng 252004,China;Department of Pathology,Liaocheng People's Hospital and Liaocheng Affiliated Hospital of Shandong First Medical University)

机构地区：[1]聊城市人民医院山东第一医科大学附属聊城医院肝胆外科,山东聊城252004 [2]聊城市人民医院山东第一医科大学附属聊城医院病理科

出　　处：《腹腔镜外科杂志》2022年第3期189-193,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨脾脏硬化性血管瘤样结节性转化(SANT)的临床病理特征及腹腔镜手术治疗的价值。方法:回顾分析2014年1月至2019年12月收治并行腹腔镜手术治疗的5例脾脏SANT患者的临床资料,结合其临床症状、影像学表现及病理特点、预后进行分析与总结。5例患者中男1例,女4例,中位年龄31岁。结果:术前影像学检查均无法确诊,4例行腹腔镜脾切除术,1例行腹腔镜脾部分切除术。术中出血量20~160 mL。病变位于脾脏上极2例、中段2例、下极1例,均为单发肿物,最长径5.5~15.0 cm。免疫组化结果显示,在血管瘤样结节内,分化程度较好的网架状毛细血管内皮细胞免疫表型呈CD31+、CD34+、CD8-,窦性腔隙内皮细胞免疫表型呈CD31+、CD34-、CD8+,而小静脉型血管内皮细胞免疫表型呈CD31+、CD34-、CD8-。5例患者随访16~67个月,均无复发。结论:SANT是罕见的脾脏良性增生性疾病,临床表现及影像学检查不典型,确诊主要依靠手术及病理学检查,通过腹腔镜脾切除或脾部分切除术可治愈。Objective:To explore the clinicopathological characteristics of sclerosing angiomatoid nodular transformation(SANT)of spleen and the value of laparoscopy in the treatment of SANT.Methods:Five patients who were treated with laparoscopy and diagnosed with SANT of spleen from Jan.2014 to Dec.2019 were enrolled.The clinical symptoms,imaging examination,pathological features and prognosis of these cases were analyzed and summarized.Among these 5 cases,there were 1 male and 4 females,and the median age was 31 years.Results:All patients could not be diagnosed by preoperative imaging.4 patients underwent laparoscopic splenectomy,one patient underwent laparoscopic partial splenectomy,with the intraoperative bleeding volume of 20-160 mL.The lesion presented as a single mass with 5.5 cm to 15.0 cm in the greatest diameter.2 cases were located in the upper pole of the spleen,2 cases were in the middle of the spleen,and 1 case was in the lower pole of the spleen.The immunohistochemical results displayed CD31+,CD34+,CD8-for cord capillary endothelial cells,CD31+,CD34-,CD8+for sinusoid-like vessel endothelial cells,CD31+,CD34-,CD8-for small vein endothelial cells.The 5 patients were followed up for 16-67 months with no evidence of recurrence.Conclusions:Splenic SANT is a rare benign proliferative disease with atypical clinical manifestations and imaging.Diagnosis of SANT mainly bases on surgery and histopathological examination.This disease can be cured by laparoscopic splenectomy and laparoscopic partial splenectomy.

关 键 词：脾脏肿瘤 硬化性血管瘤样结节性转化 腹腔镜检查 治疗 

分 类 号：R657.6[医药卫生—外科学]