脾占位性病变的诊断治疗：附68例报告

Diagnosis and treatment of splenic occupied disease:a report of 68 Cases

目的探讨脾肿瘤的临床特点和诊治方法。方法回顾性分析68例经手术及病理证实为脾肿瘤的临床资料。结果良性脾占位性病变31例(45.59%),包括脾囊肿15例,血管瘤12例,淋巴管瘤3例,脾脓肿1例。恶性37例(54.41%),包括转移癌24例,血管肉瘤1例,恶性纤维组织细胞瘤1例,淋巴瘤11例。术前B超诊断为占位性病变者57例(83.82%),CT诊断为占位性病变者62例(91.18%)。59例行脾切除,6例行脾部分切除术,2例行脾囊肿穿刺引流术,1例行穿刺活检术。良性肿瘤22例获13～114个月随访,均生存良好。恶性肿瘤23例获12～79个月随访,8例淋巴瘤生存时间为14～79个月,中位生存时间33个月,其他恶性肿瘤15例中,仅3例生存>2年,其余均在3～12个月内死亡。结论B超和CT检查是脾肿瘤的主要诊断手段,治疗上应以手术治疗为主。良性肿瘤无论行脾切除术或脾部分切除术,术后均无需特殊处理;恶性肿瘤应以手术为主,恶性淋巴瘤在脾切除术基础上行辅助化疗对延长生存期有意义,对转移癌患者尚需在术后行相应的辅助性治疗。

Objective To summarize the clinical characteristics and the experiences of diagnosis and treatment of splenic tumors. Methods A retrospective analysis was performed on the clinical data of 68 cases of splenic tumors confirmed by surgery and pathology. Results Benign masses were found in 31 patients （45.59%）, including splenic cyst in 15 patients, hemangioma in 12, lymphangioma in 3 and splenic abscess in 1; 37 （54. 41% ） patients with malignant tumors included metastatic tumors of spleen in 24, primary splenic lymphoma in 11, malignant fibrous histiocytoma in 1, and angiosarcoma in 1. The preoperative confirmed diagnostic rate by B - US was 83. 82% （57/68） and by CT was 91. 18% （62/ 68 ）. Of the 68 patients, 59 cases underwent splenectomy, 6 cases underwent partial spleneetomy, 2 cases of splenic cyst underwent percutaneous drainage and 1 case underwent puncture biopsy. Tweety-two patients with benign tumor were followed up for 7 to 114 months and all are well ; 23 of 37 patients with malignant tumor were followed up for 12 to 79 months, of them, 8 lymphoma patients survived 14 to 79 months, and in the other 15 cases, only 3 patients survived more than 2 years and 12 patients died at 3 to 12 months. Conclusions B - US and CT are the main methods of diagnosis for splenic tumors, and surgery is the main method of treatment. Benign splenic tumor does not require any other therapy after splenectomy or partial spleneetomy. Splenectomy is the treatment of choice for primary malignant splenic tumor. Adjuvantchemotherapy can prolong survival of patients with lymphoma after splenectomy. Metastatic tumors in the spleen require adjuvant treatment after operation.