脾切除术后脾组织植入的影像学特征

CT imaging features of abdominal splenosis after splenectomy

目的探讨脾切除术后脾组织植入的发生率及其cT影像特征。方法回顾性分析2010年6月至2012年12月94例经腹部增强CT证实的脾切除术患者的临床资料。根据脾切除的病因分为2组，外伤组42例和非外伤组52例。统计学方法分析脾组织植入的发生率和cT影像学特征。结果94例脾切除患者中，脾组织植入29例（30．85％）。42例外伤性脾切除者中，发现脾组织植入结节20例，发生率47．62％，非外伤性脾切除的52例中，共发现脾组织植入结节9例（发生率17．31％）。二者比较差异有统计学意义（P〈0．05）。29例脾组织植入共发现60个结节，所有结节直径均≤50mm。CT平扫表现为均匀软组织密度影，增强扫描动脉期均明显强化，门静脉期持续强化。结论继发于外伤性脾切除的腹部脾组织植入比此前报道的更常见，认识其典型的cT影像表现和既往脾切除手术史可以使这类病例避免不必要的有创性治疗。

Objective To investigate the incidence and CT imaging features of abdominal splenosis with a previous splenectomy. Methods 94 consecutive patients with a history of splenectomy underwent abdominal contrast CT examination between April 2010 and December 2012 and were recruited for this study. These patients were derided into two groups according to the reason for which splenectomy was performed. Descriptive statistics were calculated for clinical incidence of abdominal splenosis, and subsequently CT imaging features and diagnosis of abdominal splenosis were discussed. Results In this series, 29 cases （30. 85% ） with abdominal splenosis were found in 94 patients. Abdominal splenosis was found in all of 20 cases with more than one year history of posttraumatie splenectomy, and in 17.31% （9 of 52） of cases with more than one year history of non-traumatic splenectomy （ P 〈 0. 05 ）. There were 60 nodules found on CT examinations in these 29 cases. All nodules were 50 mm or smaller. All nodules appeared of homogeneous soft-tissue density on plain CT scan. The nodules showed significant enhancement during arterial phase on postcontrast CT scan, with continuous significant homogeneous enhancement during portal venous phase. Conclusions Abdominal splenosis following posttraumatic splenectomy are more common than previously suggested. Knowledge of typical CT imaging appearances and the history of splenectomy may prevent mistaking as tumors.