非寄生虫性脾囊肿3例报告及文献综合分析(1)
[摘要] 目的 总结我国非寄生虫性脾囊肿(NPSC)的诊治经验。方法 报告3例及网上搜索1973～2008年间发表的NPSC文献249篇,对临床和病理资料回顾性研究。结果 ①NPSC占脾脏良性肿瘤的33.9%,真性囊肿占59.8%;②左上腹胀痛及肿块占46.6%及50.0%;③B超或CT诊断阳性率分别为90.5%和93.4%;④开腹全脾切除占74.2%;⑤儿童全脾切除未加自体脾片移植暴发性感染占6.3%。结论 NPSC较多见,真性囊肿多于假性囊肿,左上腹胀痛及肿块为主要临床表现,影像学检查阳性率高。成人开腹全脾切除仍是主要手术方式,儿童尽可能采用全脾切除加自体脾片移植或脾部份切除。
[关键词] 脾囊肿;非寄生虫性;病例报告;文献分析
[中图分类号] R657.6[文献标识码] A [文章编号] 1673-9701(2009)36-26-03
Non-parasitic Splenic Cyst:A Report of 3 Cases and A Comprehensive Analysis of Literature
HE Jianjun
Department of General Surgery,Ningxiang People’s Hospital,Changsha 410600,China
[Abstract] Objective To summarize the diagnosis and treatment of non-parasitic splenic cyst(NPSC) in China. Methods The retrospective analysis was made of3cases report and 249 published articles of NPSC between 1973 and 2008 in the domestic network. Results ①NPSC accounted for 33.7% of spleen benign tumors, and true cyst accounted for 59.8%. ②Epiabdominal pain and mass accounted for 46.6% and 50.0%. ③The B-Ultrasound and CT positive rates were 90.5% and 93.4%. ④The whole splenectomy accounted for 74.2%. ⑤Outbreak infection caused by whole splenectomy without autogenous spleen graft in children accounted for 6.3%. Conclusion NPSCs are common and true cysts are more than false ones,with epiabdominal pain and mass as their main cinical manifestations. The imagingexamination shows higher positive rate. The whole splenectomy is the main selection of surgical approach in adult and the whole splenectomy with autogenous spleen graft or partial resection of the spleen is the main selection of surgical approach in children as far as possible.
[Key Words] Spleen cyst;Non-parasitic splenic cyst;Case report;Literature analysis
脾囊肿分为寄生虫性和非寄生虫性两大类。寄生虫性脾囊肿(parasite spleen cysts,PSC)几乎全由棘球绦虫引起。非寄生虫性脾囊肿(NPSC)根据囊肿壁有无内衬上皮,分为真性(原发性脾囊肿)和假性(继发性脾囊肿)。NPSC临床少见,但在脾脏良性肿瘤中所占比例并不低。我科自1975年以来收治3例复习文献共834例,进行临床和病理资料的回顾性研究,探讨其发病情况、临床病理特征及诊断和治疗。
1资料与方法
1.1病例资料
例1 女,43岁,左上腹胀痛2年,无外伤史,未到牧区;左上腹可及肿块,无压痛,B超示脾囊肿,CT示脾囊肿。1978年12月手术证实脾囊肿,约25cm×20cm×18cm大小,几乎占据全脾,全脾切除,病理报告脾脏上皮样囊肿,术后随访至今正常。
例2 女,18岁,左上腹胀痛5年,有车祸左上腹外伤史,左上腹可及肿块,血相正常,B超示脾囊性占位,CT示脾囊肿。2002年5月手术证实脾囊肿,18cm×18cm×12cm大小,下极部分脾组织正常,全脾切除,病理报告脾脏假性囊肿,术后曾一度红细胞及血小板增高,后恢复正常,随访6年正常。
例3 男,57岁,上腹痛3日急入院,生命体征正常,巩膜不黄,全腹膜炎征,B超示胆囊多发中小结石,胰腺增大,血淀粉酶1000U,CT示胰腺增大,周围渗出,胰体尾散在坏死,脾脏囊肿10cm×10cm大小,诊断胆囊结石,胆源性胰腺炎,脾囊肿。保守治疗20日治愈,2个月后左上腹胀痛,CT示脾囊肿10cm×10cm大小,胰体尾2个囊肿,分别为4cm×5cm及11cm×9cm大小,诊断脾囊肿并胰腺假性囊肿,继续保守治疗4个月,CT复查胰腺囊肿均消失,脾囊肿无变化,2006年6月手术证实胰腺无囊肿,脾囊肿12cm×13cm×20cm,位于脾中部,全脾切除,病理报告脾表皮样囊肿,随访至今正常。
1.2一般资料
脾脏良性肿瘤2460例中NPSC有834例(33.9%,95%CI 32.0 ～35.8)。其中男性402例,女性432例,年龄2～80岁,平均38.1岁,<14岁者43例(5.2%,95%CI:3.7～6.7),>60岁者64例(7.7%, 95%CI:4.8～10.6)。14～60岁者727例(87.2%,95%CI:84.9～89.5)。834例NPSC和499例真性脾囊肿病理诊断分类见表1,假性(继发性)脾囊肿中有腹部外伤史者86例(39.6%,95%CI:33.1～46.1)。囊肿大小平均13.7cm(1.0～47cm),其中真性脾囊肿大小平均13.6cm(3～38cm),假性脾囊肿平均15.0cm(4～47cm),肿瘤性脾囊肿平均8.7cm(1.0～15cm);单个囊肿718例(86.1%,95%CI:83.8～88.4),多个囊肿116例(13.9%,95%CI: 11.6～16.2),囊肿部位及囊液性态见表2。囊液量平均1541mL(200～9500mL)。囊肿壁钙化28例(3.3%),囊肿破裂16例(1.9%),并胰腺假性囊肿11例(1.1%);其他少见的合并病症:多囊肝多囊肾5例,游走脾5例,胃壁囊肿1例,肝囊肿卵巢囊肿1例,慢性粒细胞性白血病1例,胰头癌1例,胃癌1例,出血倾向2例,红细胞增多症1例,脾亢2例,胰腺假性囊肿破裂4例,脾被膜下血肿2例,CA-199升高1例,食管癌2例,肝包虫病1例,肝癌1例,胸腔积液1例。, 百拇医药(何建军)
[关键词] 脾囊肿;非寄生虫性;病例报告;文献分析
[中图分类号] R657.6[文献标识码] A [文章编号] 1673-9701(2009)36-26-03
Non-parasitic Splenic Cyst:A Report of 3 Cases and A Comprehensive Analysis of Literature
HE Jianjun
Department of General Surgery,Ningxiang People’s Hospital,Changsha 410600,China
[Abstract] Objective To summarize the diagnosis and treatment of non-parasitic splenic cyst(NPSC) in China. Methods The retrospective analysis was made of3cases report and 249 published articles of NPSC between 1973 and 2008 in the domestic network. Results ①NPSC accounted for 33.7% of spleen benign tumors, and true cyst accounted for 59.8%. ②Epiabdominal pain and mass accounted for 46.6% and 50.0%. ③The B-Ultrasound and CT positive rates were 90.5% and 93.4%. ④The whole splenectomy accounted for 74.2%. ⑤Outbreak infection caused by whole splenectomy without autogenous spleen graft in children accounted for 6.3%. Conclusion NPSCs are common and true cysts are more than false ones,with epiabdominal pain and mass as their main cinical manifestations. The imagingexamination shows higher positive rate. The whole splenectomy is the main selection of surgical approach in adult and the whole splenectomy with autogenous spleen graft or partial resection of the spleen is the main selection of surgical approach in children as far as possible.
[Key Words] Spleen cyst;Non-parasitic splenic cyst;Case report;Literature analysis
脾囊肿分为寄生虫性和非寄生虫性两大类。寄生虫性脾囊肿(parasite spleen cysts,PSC)几乎全由棘球绦虫引起。非寄生虫性脾囊肿(NPSC)根据囊肿壁有无内衬上皮,分为真性(原发性脾囊肿)和假性(继发性脾囊肿)。NPSC临床少见,但在脾脏良性肿瘤中所占比例并不低。我科自1975年以来收治3例复习文献共834例,进行临床和病理资料的回顾性研究,探讨其发病情况、临床病理特征及诊断和治疗。
1资料与方法
1.1病例资料
例1 女,43岁,左上腹胀痛2年,无外伤史,未到牧区;左上腹可及肿块,无压痛,B超示脾囊肿,CT示脾囊肿。1978年12月手术证实脾囊肿,约25cm×20cm×18cm大小,几乎占据全脾,全脾切除,病理报告脾脏上皮样囊肿,术后随访至今正常。
例2 女,18岁,左上腹胀痛5年,有车祸左上腹外伤史,左上腹可及肿块,血相正常,B超示脾囊性占位,CT示脾囊肿。2002年5月手术证实脾囊肿,18cm×18cm×12cm大小,下极部分脾组织正常,全脾切除,病理报告脾脏假性囊肿,术后曾一度红细胞及血小板增高,后恢复正常,随访6年正常。
例3 男,57岁,上腹痛3日急入院,生命体征正常,巩膜不黄,全腹膜炎征,B超示胆囊多发中小结石,胰腺增大,血淀粉酶1000U,CT示胰腺增大,周围渗出,胰体尾散在坏死,脾脏囊肿10cm×10cm大小,诊断胆囊结石,胆源性胰腺炎,脾囊肿。保守治疗20日治愈,2个月后左上腹胀痛,CT示脾囊肿10cm×10cm大小,胰体尾2个囊肿,分别为4cm×5cm及11cm×9cm大小,诊断脾囊肿并胰腺假性囊肿,继续保守治疗4个月,CT复查胰腺囊肿均消失,脾囊肿无变化,2006年6月手术证实胰腺无囊肿,脾囊肿12cm×13cm×20cm,位于脾中部,全脾切除,病理报告脾表皮样囊肿,随访至今正常。
1.2一般资料
脾脏良性肿瘤2460例中NPSC有834例(33.9%,95%CI 32.0 ～35.8)。其中男性402例,女性432例,年龄2～80岁,平均38.1岁,<14岁者43例(5.2%,95%CI:3.7～6.7),>60岁者64例(7.7%, 95%CI:4.8～10.6)。14～60岁者727例(87.2%,95%CI:84.9～89.5)。834例NPSC和499例真性脾囊肿病理诊断分类见表1,假性(继发性)脾囊肿中有腹部外伤史者86例(39.6%,95%CI:33.1～46.1)。囊肿大小平均13.7cm(1.0～47cm),其中真性脾囊肿大小平均13.6cm(3～38cm),假性脾囊肿平均15.0cm(4～47cm),肿瘤性脾囊肿平均8.7cm(1.0～15cm);单个囊肿718例(86.1%,95%CI:83.8～88.4),多个囊肿116例(13.9%,95%CI: 11.6～16.2),囊肿部位及囊液性态见表2。囊液量平均1541mL(200～9500mL)。囊肿壁钙化28例(3.3%),囊肿破裂16例(1.9%),并胰腺假性囊肿11例(1.1%);其他少见的合并病症:多囊肝多囊肾5例,游走脾5例,胃壁囊肿1例,肝囊肿卵巢囊肿1例,慢性粒细胞性白血病1例,胰头癌1例,胃癌1例,出血倾向2例,红细胞增多症1例,脾亢2例,胰腺假性囊肿破裂4例,脾被膜下血肿2例,CA-199升高1例,食管癌2例,肝包虫病1例,肝癌1例,胸腔积液1例。, 百拇医药(何建军)