多层螺旋CT对活体人脾体积的评估

目的 运用16层螺旋CT测量成人正常脾体积及容积相关参数,探讨脾体积与年龄、身高和体重等参数的关系,提供一个脾体积的简易估测方法。 方法 对无明确脾疾病的510例患者进行16层螺旋CT腹部增强扫描,针对1mm层厚、0.5mm重建间隔的门脉期图像进行分析。采用东芝公司Volume体积测量软件测定脾的体积、脾上下径、左右径、前后径、厚度和最大截面积,并对测量结果进行统计分析。 结果 510例患者的平均脾体积为(203±79)cm³。平均脾上下径、左右径、前后径、厚度和最大截面积分别为(9.0±1.7)cm、(9.1±1.0)cm、(9.5±1.9)cm、(3.8±0.7)cm及(35.6±9.5)cm²。体积与身高、体重存在较弱的正相关关系,与年龄间存在较弱的负相关关系。消除了体重因素的影响后,两性间脾体积无显著差异。脾体积与脾上下径及脾最大截面积均具有很好的正相关性(r=0.787 6, P<0.01;r=0.865 1, P<0.01)。简化的回归方程为：脾体积＝0.616×脾上下径×脾最大截面积(t=109.7, r²=0.990 6, P<0.01)。诊断脾肿大的标准是:脾体积大于358cm³为脾增大。 结论 本研究与传统的脾体积估算方法相比,可简单、迅速而较准确地估测脾体积,操作方法便于掌握,有较好的临床应用价值。     

Spleen size of live donors for liver transplantation

BACKGROUND: Normal spleen size is not well defined for the adult population. METHODS: Abdominal computed tomography (CT) scans of 238 consecutive living donors for liver transplantation were studied. Two methods for determining splenomegaly were applied. In Method N, a horizontal line was drawn to the left side from the most ventral point of the spleen. A perpendicular line was drawn from the central point of the aorta of the CT slice. The height of the cross point of the two lines was compared with the diameter of the aorta. In Method C, a perpendicular line was drawn from the most ventral point of the spleen. The distance between the posterior and anterior abdominal walls was partitioned in three parts, from dorsal to ventral and defined of Zones 1, 2, and 3, respectively. Donors were divided into two groups, those under age 40 and those over age 40. RESULTS: The mean volume of the spleen was 123 +/- 45 cm(3). Spleen volume was negatively correlated with age (R = -0.32, p < 0.001) and positively correlated with body mass (R = 0.24, p < 0.001). In donors under age 40, the most ventral point of the 96% of the spleens was below four times the diameter of the aorta (Method N). In Method C, 52% of the spleens were located in Zones 1 and 2. In donors over age 40, the most ventral point of the 96% of the spleens was below three times the diameter of the aorta (Method N). Totally 82% of the spleens were located in Zones 1 and 2 (Method C). CONCLUSIONS: Splenomegaly can be evaluated by the simple method on CT although the threshold must be changed by the age of the subject.     

The anatomy and pathology of the porta hepatis demonstrated by gray scale ultrasonography

Gray scale ultrasound has proved to be a simple, rapid, and reliable means for the investigation of cholestatic jaundice. The distended biliary tree has a characteristic but sometimes confusing appearance on ultrasonic tomography. Gray scale ultrasound can diagnose portal hypertension by visualizing an enlarged, tortuous portal vein. This can be differentiated from the typical shape of the dilated common bile duct by the condition of the intrahepatic biliary canaliculi and by examination of the spleen.     

101 laparoscopic splenectomies for the treatment of benign and malignant hematologic disorders

BACKGROUND: Laparoscopic splenectomy (LS) is the surgical approach of choice for patients with hematologic disorders requiring splenectomy. Patients with idiopathic thrombocytopenic purpura (ITP) have normal to slightly enlarged spleens and benefit the most from LS. METHODS: We reviewed the perioperative outcomes in 101 patients who underwent LS between May 1996 and December 2002. Patients were divided into three groups--ITP, other benign, and malignant hematologic disorders--and compared. RESULTS: The ITP patients (n = 48) had significantly smaller spleens and operative times compared with the other groups. Splenomegaly in the other benign (n = 23) and malignant hematologic disorders (n = 30) groups was responsible for higher open conversion rates and greater need for hand-assisted laparoscopic splenectomy (HALS). CONCLUSIONS: Laparoscopic splenectomy and HALS can be performed with good results for benign and malignant hematologic disorders. The benefits of HALS are similar to LS, so there should be a low threshold for HALS in patients with large spleens.     

Patients with severe schistosomiasis mansoni in Ituri Province,Democratic Republic of the Congo

Background::Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in end...     

Volumetric Splenomegaly in Patients With Polycythemia Vera

BackgroundNon-palpable splenomegaly in patients with polycythemia vera (PV) has seldom been addressed. In this retrospective study, we evaluated non-palpable, volumetric splenomegaly defined based on age- and body surface area (BSA)–matched criteria in patients with PV diagnosed according to the 2016 World Health Organization diagnostic criteria.MethodsPatients with PV who underwent abdominal computed tomography (CT) and who had palpable splenomegaly at diagnosis from January 1991 to December 2020 at Chungnam National University Hospital were enrolled. The spleen volume of each patient was determined by volumetric analysis of abdominal CT and adjusted for the patient’s age and BSA. Then the degree of splenomegaly was classified as no splenomegaly, borderline volumetric splenomegaly, overt volumetric splenomegaly, or palpable splenomegaly.ResultsOf the 87 PV patients enrolled, 15 (17.2%) had no splenomegaly, whereas 17 (19.5%), 45 (51.7%), and 10 (11.5%) had borderline volumetric, overt volumetric, and palpable splenomegaly, respectively. The degree of splenomegaly did not affect the cumulative incidence of thrombotic vascular events (10-year incidence: 7.7%, 0%, 22.3%, and 50.7%, respectively, P = 0.414). By contrast, splenomegaly tended to adversely affect myelofibrotic transformation (10-year cumulative incidence: 0%, 0%, 7.1%, and 30.3%, respectively, P = 0.062). Moreover, the cumulative incidence of myelofibrotic transformation was significantly higher in patients with overt volumetric or palpable splenomegaly than those with no or borderline volumetric splenomegaly (10-year incidence: 0% vs. 10.3%, respectively; 15-year incidence: 0% vs. 26.3%, respectively, P = 0.020). Overall survival (OS) differed among patients with different degrees of splenomegaly (15-year OS: 100%, 78.6%, 71.7%, and 51.9%, respectively, P = 0.021).ConclusionThe degree of splenomegaly, including volumetric splenomegaly, based on age- and BSA-matched reference spleen volumes at diagnosis reflects disease progression in PV patients. Therefore, volumetric splenomegaly should be evaluated at the time of diagnosis and taken into consideration when predicting the prognosis of patients with PV.     

YKL-40蛋白与门静脉高压脾脏肿大纤维化重塑进程的研究

目的：探讨YKL-40蛋白在人门静脉高压脾脏组织中的表达及临床意义。 方法：采用免疫组织化学法检测人正常脾脏组织14份及门静脉高压脾脏组织48份中YKL-40蛋白表达情况,Masson三色染色检测脾脏纤维化程度。 结果：门静脉高压患者脾脏YKL-40蛋白表达明显高于正常脾脏,两组YKL-40表达差异具有统计学意义（P 〈 0.05）,且其表达程度随Child-Pugh分级增高而增高（P 〈 0.05）。YKL-40蛋白表达与患者自由门静脉压力（FPP）呈正相关（R = 0.499,P 〈 0.01）。门静脉高压脾脏中纤维增生较正常脾脏增生明显（P 〈 0.05）,YKL-40蛋白表达与纤维化程度呈正相关（R = 0.857,P 〈 0.01）。 结论：YKL-40在门静脉高压脾脏中表达增高,且表达水平与FPP、Child-Pugh分级相关。YKL-40表达与脾脏纤维化程度成正相关,提示YKL-40可能参与门静脉高压脾脏纤维化重塑过程。YKL-40蛋白可能成为治疗门静脉高压脾大的重要生物治疗因子。     

手助腹腔镜巨脾切除术临床分析

目的探讨对巨脾行手助腹腔镜脾切除术(hand-assisted laparoscopic splenectomy,HALS)的可行性、安全性和手术技巧。方法2005年1月~2006年12月,对门脉高压性巨脾40例,采用HALS(n=15)或开腹脾切除(open splenectomy,OS)(n=25)。2组年龄、性别、肝功能分级、脾脏大小相似。结果2组未发生严重手术并发症。与OS组相比,HALS组术中出血多[(312±61)ml vs(235±105)ml,t=2.583,P=0.014],手术时间长[(95±20)min vs(73±16)min,t=3.832,P=0.000],术后肠功能恢复早[(48±1)h vs(98±1)h,t=-153.093,P=0.000],术后住院时间短[(6±2)d vs(10±2)d,t=-6.124,P=0.000)]。结论手助腹腔镜巨大脾脏切除是安全、可行的。与开腹脾脏切除相比,虽然手术时间长,但是术后恢复快、住院时间短。     

Lymphomes spléniques : diagnostic et prise en charge

Some common clinical situations, such as splenomegaly or lymphocytosis, or less common, such as autoimmune hemolytic anemia, cold agglutinin disease, or cryoglobulinemia can lead to the diagnosis of splenic lymphoma. Splenic lymphoma is rare, mainly of non-hodgkinian origin, encompassing very different hematological entities in their clinical and biological presentation from an aggressive form such as hepato-splenic lymphoma to indolent B-cell lymphoma not requiring treatment such as marginal zone lymphoma, the most frequent form of splenic lymphoma. These entities can be challenging to diagnose and differentiate. This review presents different clinical and biological manifestations suspicious of splenic lymphoma and proposes a diagnosis work-up. We extended the strict definition of splenic lymphoma (lymphoma exclusively involving the spleen) to lymphoma thant can be revealed by a splenomegaly and we discuss the differential diagnosis of splenomegaly.