脾脏占位性病变的诊断和治疗：附22例报告
周党军 晁延军 蒋安 安东均
摘 要
目的：探讨脾脏占位性病变的临床特点及诊治。
方法：对1992年1月～2009年12月期间收治的22例脾脏占位患者的临床资料进行回顾性分析。
结果：全组良性占位18例，其中脾囊肿4例，脾血管瘤11例，脾脓肿3例；恶性占位4例，其中恶性淋巴瘤2例，胰腺癌脾转移1例，胃癌术后肝脾转移1例。20例行全脾切除术，2例部分脾脏切除。2例恶性淋巴瘤和2例转移癌患者中1例失访，1例1年后死亡，1例2年后死亡，1例2年半后死亡，良性病变均痊愈。
结论：脾脏占位性病变的诊断主要靠临床表现及影像学检查，良恶性可根据超声造影、CT或选择性脾动脉造影，治疗以外科手术为主，恶性占位应辅以放疗和化疗。
关键词
脾肿瘤/外科学；脾肿瘤/诊断
Diagnosis and management of space-occupying lesions of the spleen:a report of 22 cases
ZHOU Dangjun，CHAO Yanjun，JIANG An，AN Dongjun
ABSTRACT
Objective:To investigate the diagnosis and treatment of the space-occupying lesions of the spleen.
Methods:The clinical data of 22 patients，who had space-occupying lesions of the spleen，admitted from January 1992 to December 2009 were retrospectively analyzed.
Results:Of the entire group，18 cases were benign space-occupying lesions that included 4 cases of splenic cyst，11 cases of splenic hemangioma，and 3 cases of splenic abscess；4 cases were malignant space-occupying lesions that included 2 cases of malignant lymphoma，and one case each of splenic metastasis from pancreatic cancer and metastases in the liver and splenic following surgery for stomach cancer.Twenty-six patients underwent total splenectomy and 2 patients underwent partial splenectomy.Of the 2 malignant lymphoma and 2 splenic metastasis patients，one case was lost to follow-up，and the other 3 cases died one year，2 years and 2.5 years aft er operation，respectively.All the benign patients were cured.
Conclusion:The diagnosis of space-occupying lesions in the spleen is mainly based on clinical manifestation and imageological examination.Differentiation of benignancy or malignancy of the lesions depends on contrast-enhanced ultrasonography，CT or selective splenic artery angiography.For these patients，surgical treatment is the major therapeutic alternative，while adjuvant radiotherapy and chemotherapy is required for the malignant cases.
KEY WORDS
Splenic Neoplasm/surg；Splenic Neoplasm/diag
脾脏占位性病变临床少见，原发性脾恶性肿瘤占全身恶性肿瘤不足1%。脾脏不同性质的占位性病变其自然病变过程可完全不同，如脾脏恶性肿瘤的预后极差，其生存期仅在2年以内。因此加强对脾脏占位性病变的认识，提高对脾脏各种占位性病变的鉴别诊断，以及对其早期的正确治疗是改善预后的关键［1］。随着医学影像学的发展和广泛应用，临床收治的脾脏占位性病变的患者日益增多，但是临床确诊及治疗有一定难度，笔者就咸阳市中心医院17年来收治的22例脾脏占位性病变的诊断和治疗进行分析，报告如下。