脾脏肿瘤31例临床分析

目的 通过临床病例分析,了解脾脏肿瘤的临床特点。方法 对1990年1月－2000年12月期间收治的31例脾脏肿瘤患者的临床表现、影像学特点和诊断依据、治疗情况进行了分析。结果 31例脾脏肿瘤中良性肿瘤居多（20／31）。临床表现无特异性。影像学特点为脾实质内单发或多发结节。全部患者均是先行B超检查发现脾脏占位,其中19例又行CT检查,7例行MRI检查。7例脾囊肿通过B超等影像学检查明确诊断,其中6例在手术后病理证实;9例脾脏转移性肿瘤通过影像学检查并结合病史在术前明确诊断,有5例经手术切除后病理证实;另外15例脾脏病变,除1例因术前CT检查明确为脾脏淋巴管瘤而放弃手术外,其余14例则以脾脏肿瘤而行脾脏切除手术,术后病理明确诊断。全组31例患者中,25例行脾切除术,术后恢复均较顺利,无手术死亡。结论 病史和影像学检查是诊断脾脏肿瘤的重要依据,术前不易鉴别良恶性肿瘤,手术效果佳。

Diagnosis and treatment of 31 patients with splenic tumors

Objective Splenic tumor,a rare disease,is scarcely mentioned in the literature. Here, we wish to present a clinical study on 31 such patients treated in the PLA General Hospital with emphasis on diagnosis and treatment.Methods Thirty one splenic tumor patients were treated from January 1990 to December 2000. The clinical manifestations and image characteristics of splenic tumor, diagnosis and treatment were analysed.Results Male 19, female 12. Their ages ranged from 13 to 80 years with an average of 56. The symptoms and signs were non specific.All patiens were first diagnosed by beta ultrasonography to have single or multiple space occupying lesions. Then, 19 patients received CT and 7 MRI scans.The diagnosis of seven patients suffering from splenic cysts were initially made definite by beta ultrasonography among whom the lesions of 6 were confirmed by operation and pathology. The diagnosis of 9 patients with metastatic tumor was ascertained by combined imaging and clinical history. Finally, the lesions were confirmed by operation and pathology. Fifteen patients with primary splenic tumor were found to have primary space occupying lesion by imaging: Except one patient who was diagnosed to have splenic lymphoma and not operated,all the other 14 patients underwent splenectomy with their lesions confirmed by pathology. Altogether, 25 of these 31 patients were treated by splenectomy with uneventful recovery without any operative mortality.Final pathologic examination disclosed that 20(65%) of 31 lesions were benign.Conclusion Clinical history and imaging scans are important in the diagnosis of splenic tumors. The differentiation of benignity and malignancy is difficult before operation.Surgery is satisfactory in treating splenic tumors.