副脾的临床诊断与误诊原因分析(附8例报道)

目的探讨副脾的临床诊断方法和副脾误诊的原因。方法回顾分析8例副脾患者的诊疗过程,进一步探讨副脾的误诊原因。结果一例经超声检查诊断,两例经CT检查诊断,此三例随访2～3年,复查均未发现异常;一例可疑患者要求行手术处理,术后病理证实为副脾,其余四例分别误诊为肝脏肿瘤一例,卵巢囊肿一例,肾上腺肿瘤两例。结论典型的副脾有典型的影像学表现及常见发生部位,多数可在术前作出明确诊断,但是位于不典型部位或伴发梗死的副脾常容易发生误诊,积极完善术前血尿生化检查,完善超声检查,重视CT三维重建、MRI甚至核素扫描并结合临床表现,熟悉副脾可能出现的少见解剖部位,可以减少副脾的误诊率,提高术前正确诊断率。

Clinical diagnosis and cause analysis of misdiagnosis in accessory spleens cases

Aim To explore the clinical diagnosis methods of accessory spleens and the possible causes of their misdiagnosis.Methods The diagnosing and treating process of eight cases of accessory spleens were retrospectively analyzed to discuss the causes of the misdiagnosis of accessory spleen further.Results Among three diagnosed cases,one was diagnosed by Supersonic and the other two cases were diagnosed by CT,which were followed up 2～3 years.The review showed no abnormalities.One case suspected as accessory spleen required surgical treatment,pathologically confirmed as deputy spleen after surgery.The remaining four cases were misdiagnosed as liver cancer（n=1）,ovarian cysts（n=1）,adrenal tumors（n=2）.Conclusion Typical accessory spleen has the typical imaging findings and common occurrence sites,most of which can be definitely diagnosed before surgery.But the accessory spleens which located in atypical areas or with infarct are easily to be misdiagnosed.Improving the preoperative blood and urine biochemical examinationactively,completing ultrasound examination,emphasizing on three-dimensional CT reconstruction and MRI or radionuclide scanning,familiarizing with the rare anatomic site of accessory spleen,help in reducing the misdiagnosis rate of accessory spleens and improving the rate of correct diagnosis before surgery.