中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
9期
708-710
,共3页
陈胜%刘双海%沈伟%陶国青%蔡兵%陆培华
陳勝%劉雙海%瀋偉%陶國青%蔡兵%陸培華
진성%류쌍해%침위%도국청%채병%륙배화
脾脏占位性病变%诊断%治疗
脾髒佔位性病變%診斷%治療
비장점위성병변%진단%치료
Splenic space occupying lesions%Diagnosis%Treatment
目的 探讨伴有并存疾病的脾脏占位性病变的诊断和治疗.方法 回顾性分析2002年1月至2012年6月江阴市人民医院收治的5例和无锡市人民医院收治的9例伴有并存疾病的脾脏占位性病变患者的临床资料.术前行B超和CT检查,根据患者术前影像学检查结果施行脾切除术或联合器官切除术.术后根据病理检查结果选择化疗方案.采用门诊和电话随访至2013年6月.结果 脾脏占位性病变多无特异性症状,其中以左季肋区不适、胀痛为首发症状的4例,其余10例患者均无症状.患者术前诊断符合率为10/14,其中并存疾病为恶性肿瘤的患者术前诊断符合率为2/5.术前B超检查14例,明确诊断9例.CT检查9例,明确诊断7例.14例患者中,右侧卵巢癌、双侧卵巢癌与乙状结肠癌患者均与术后孤立性脾转移相关；其他11例患者的并存疾病与脾脏占位性病变不相关.合并左半结肠癌及2型糖尿病的脾脉管瘤患者、合并肾癌的脾硬化性血管瘤样转化患者和合并高血压及胆囊结石的脾淋巴管瘤患者的并存疾病和脾脏占位性病变为同期发现.其余11例患者的并存疾病与脾脏占位性病变为先后发现.14例患者中行单纯脾切除10例,行脾切除联合其他脏器切除4例.5例经病理检查明确的脾脏恶性占位性病变患者术后根据并存疾病选择化疗方案进行治疗.患者术后恢复均顺利,无全身凶险性感染发生.14例患者中,2例脾肉瘤患者分别于术后半年和1年出现全身转移；合并右侧卵巢癌的孤立性脾转移患者随访3年出现横结肠转移；合并双侧卵巢癌的孤立性脾转移患者随访2年出现腹腔广泛转移；合并乙状结肠癌的孤立性脾转移患者,术后4年死于腹腔肿瘤复发；合并左半结肠癌、2型糖尿病的脾脉管瘤患者因左半结肠癌分期早,随访6年仍生存.其余9例并存疾病为良性疾病的患者随访时间内均生存.结论 伴有并存疾病的脾脏占位性病变的患者依靠术前影像学和术后病理检查确诊,在排除绝对手术禁忌证后采取外科治疗安全可靠,预后由并存疾病的进展和脾脏占位性病变的肿瘤性质共同决定.
目的 探討伴有併存疾病的脾髒佔位性病變的診斷和治療.方法 迴顧性分析2002年1月至2012年6月江陰市人民醫院收治的5例和無錫市人民醫院收治的9例伴有併存疾病的脾髒佔位性病變患者的臨床資料.術前行B超和CT檢查,根據患者術前影像學檢查結果施行脾切除術或聯閤器官切除術.術後根據病理檢查結果選擇化療方案.採用門診和電話隨訪至2013年6月.結果 脾髒佔位性病變多無特異性癥狀,其中以左季肋區不適、脹痛為首髮癥狀的4例,其餘10例患者均無癥狀.患者術前診斷符閤率為10/14,其中併存疾病為噁性腫瘤的患者術前診斷符閤率為2/5.術前B超檢查14例,明確診斷9例.CT檢查9例,明確診斷7例.14例患者中,右側卵巢癌、雙側卵巢癌與乙狀結腸癌患者均與術後孤立性脾轉移相關；其他11例患者的併存疾病與脾髒佔位性病變不相關.閤併左半結腸癌及2型糖尿病的脾脈管瘤患者、閤併腎癌的脾硬化性血管瘤樣轉化患者和閤併高血壓及膽囊結石的脾淋巴管瘤患者的併存疾病和脾髒佔位性病變為同期髮現.其餘11例患者的併存疾病與脾髒佔位性病變為先後髮現.14例患者中行單純脾切除10例,行脾切除聯閤其他髒器切除4例.5例經病理檢查明確的脾髒噁性佔位性病變患者術後根據併存疾病選擇化療方案進行治療.患者術後恢複均順利,無全身兇險性感染髮生.14例患者中,2例脾肉瘤患者分彆于術後半年和1年齣現全身轉移；閤併右側卵巢癌的孤立性脾轉移患者隨訪3年齣現橫結腸轉移；閤併雙側卵巢癌的孤立性脾轉移患者隨訪2年齣現腹腔廣汎轉移；閤併乙狀結腸癌的孤立性脾轉移患者,術後4年死于腹腔腫瘤複髮；閤併左半結腸癌、2型糖尿病的脾脈管瘤患者因左半結腸癌分期早,隨訪6年仍生存.其餘9例併存疾病為良性疾病的患者隨訪時間內均生存.結論 伴有併存疾病的脾髒佔位性病變的患者依靠術前影像學和術後病理檢查確診,在排除絕對手術禁忌證後採取外科治療安全可靠,預後由併存疾病的進展和脾髒佔位性病變的腫瘤性質共同決定.
목적 탐토반유병존질병적비장점위성병변적진단화치료.방법 회고성분석2002년1월지2012년6월강음시인민의원수치적5례화무석시인민의원수치적9례반유병존질병적비장점위성병변환자적림상자료.술전행B초화CT검사,근거환자술전영상학검사결과시행비절제술혹연합기관절제술.술후근거병리검사결과선택화료방안.채용문진화전화수방지2013년6월.결과 비장점위성병변다무특이성증상,기중이좌계륵구불괄、창통위수발증상적4례,기여10례환자균무증상.환자술전진단부합솔위10/14,기중병존질병위악성종류적환자술전진단부합솔위2/5.술전B초검사14례,명학진단9례.CT검사9례,명학진단7례.14례환자중,우측란소암、쌍측란소암여을상결장암환자균여술후고립성비전이상관；기타11례환자적병존질병여비장점위성병변불상관.합병좌반결장암급2형당뇨병적비맥관류환자、합병신암적비경화성혈관류양전화환자화합병고혈압급담낭결석적비림파관류환자적병존질병화비장점위성병변위동기발현.기여11례환자적병존질병여비장점위성병변위선후발현.14례환자중행단순비절제10례,행비절제연합기타장기절제4례.5례경병리검사명학적비장악성점위성병변환자술후근거병존질병선택화료방안진행치료.환자술후회복균순리,무전신흉험성감염발생.14례환자중,2례비육류환자분별우술후반년화1년출현전신전이；합병우측란소암적고립성비전이환자수방3년출현횡결장전이；합병쌍측란소암적고립성비전이환자수방2년출현복강엄범전이；합병을상결장암적고립성비전이환자,술후4년사우복강종류복발；합병좌반결장암、2형당뇨병적비맥관류환자인좌반결장암분기조,수방6년잉생존.기여9례병존질병위량성질병적환자수방시간내균생존.결론 반유병존질병적비장점위성병변적환자의고술전영상학화술후병리검사학진,재배제절대수술금기증후채취외과치료안전가고,예후유병존질병적진전화비장점위성병변적종류성질공동결정.
Objective To investigate the diagnosis and treatment of splenic space occupying lesions associated with comorbidity.Methods The clinical data of 5 patients from Jiangyin People' s Hospital and 9 patients from Wuxi People's Hospital from January 2002 to June 2012 were retrospectively analyzed.All the patients suffered from splenic space occupying lesions associated with comorbidity.Splenectomy or multi-visceral resection were selected according to the results of preoperative B sonography and computed tomography examination.Chemotherapy regimes were selected based on postoperative pathological examination.All the patients were followed up till June 2013.Results The symptoms of patients with splenic space occupying lesions were non-specific.The first symptoms of 4 patients were discomfort or distending pain of left upper abdomen,and the other 10patients had no symptoms.The coincidence rate of preoperative diagnosis was 10/14,and the coincidence rate of preoperative diagnosis for patients with malignant tumors was 2/5.Fourteen patients received preoperative B ultra-sonography,and 9 were definitively diagnosed.Nine patients received computed tomography,and 7 were definitively diagnosed.Of the 14 patients,right ovarian cancer,bilateral ovarian cancer and sigmoid colon cancer were correlated with solitary splenic metastasis,and the main lesions of the other 11 patients were not correlated with splenic space occupying lesions.The main lesions of patients with left colon carcinoma,type 2 diabetes and vascular tumor of the spleen,patients with renal carcinoma and splenic sclerosing hemangioma,and patients with hypertension,cholecystolithiasis and splenic lymphangioma were diagnosed simultaneously with the splenic space occupying lesions,and the main lesions of theother 11 patients were diagnosed separately with the splenic space occupying lesions.Ten patients underwent simple splenectomy and 4 patients received multi-visceral resection.Chemotherapy regimens were selected according to the type of main lesions for 5 patients who were diagnosed by pathological examinations.All the patients were recovered smoothly with no occurrence of severe infections.Two patients with splenic sarcoma had tumor metastasis at postoperative 6 months and 1 year,respectively.One patient with right ovarian cancer and solitary splenic metastasis had transverse colonic metastasis at postoperative 3 years.One patient with bilateral ovarian cancer and solitary splenic metastasis had peritoneal metastasis at postoperative 2 years.One patient with sigmoid colon cancer and solitary splenic metastasis died of peritoneal tumor recurrence at postoperative 4 years.One patient with left colon carcinoma,type 2diabetes and vascular tumor of the spleen survived for 6 years and was still sound and well.The other 9 patients with benign disease survived within the period of follow-up.Conclusions The definitive diagnosis for patients with splenic space occupying disease associated with comorbidity depends on the preoperative imaging examination and postoperative pathological examination.Surgical treatment is safe when operative contraindications are excluded.The prognosis of patients is determined by the progress of main lesions and the character of splenic space occupying lesions.
