膈下占位性病变鉴别与诊断

Diagnosis and differential diagnosis of space-occupying lesions below the diaphragm

目的 提高膈下占位性病变的诊治水平。方法 分析了近5年13例膈下占位性病变初步诊断不清的患者。结果 膈下病变来源以肝脏为主，占46.2%，其余为胃、脾、胰腺等。3例术前确诊，9例术中确诊，1例于术后病理确诊。其中2例曾误诊：将肝占位误诊为肺癌和将纵膈肿瘤误诊为肝占位各1例。绝大多数病变呈“外生性”生长，形成一巨大包块，与原发脏器之间仅有一蒂相连，影像学检查难以诊断，难与胸腔或纵膈占位区别。结论 诊断和鉴别需要详细的病史和系统的体格检查；血管造影对诊断有一定的帮助；腹腔镜检查可明确病变是否来自膈下，避免不必要的剖腹探查。

Objective To improve the diagnosis and treatment of the space-occupying lesions below the diaphragm. Method Thirteen cases of space-occupying lesions below the diaphragm in recent 5 years were reviewed, the initial diagnosis of which failed to be conclusive. Results Ultrasonic and CT scan showed huge masses below the diaphragm in all cases. These space-occupying lesions were found in the liver in 6 cases, and in other cases, the stomach, spleen, pancreas and lesser omentum were involved. Three cases were diagnosed preoperatively，9 cases during the operation, and 1 case had a post-operative diagnosis by pathological examination. Misdiagnosis occurred in 2 cases. Conclusions Diagnosis and differential diagnosis of space-occupying lesions below the diaphragm need detailed medical history and systemic physical examination. Digital subtracted angiography may help in establish the diagnosis, and video-laparoscopic may help in designing surgical approach and making choice of incision.