原发性脾肿瘤39例诊治分析

目的：探讨原发性脾肿瘤的临床特点、诊断和治疗。方法：回顾性分析我院1996年1月-2007年1月收治的经手术和病理证实的39例原发性脾肿瘤临床资料。结果：在脾良性肿瘤20例中，计有脾血管瘤10例，脾囊肿8例。脾淋巴管瘤1例及脾错构瘤1例。在恶性肿瘤19例中，有脾恶性淋巴瘤18例和血管肉瘤1例。B超和CT检查术前定位诊断的准确率均为100％；B超总的定性诊断率和对脾囊肿、脾血管瘤的定性诊断率分别为12．82％（5/9）、50％（4／8）和10％（1／10）；CT总的定性诊断率和对脾囊肿、脾血管瘤的定性诊断率分别为32．43％（12，37）、83．33％（5／6）和70％（7／10），总体优于B超。B超和CT均不能肯定地作出恶性诊断。所有病例均行手术治疗，主要为脾切除术。恶性淋巴瘤术后辅以CHOP化疗方案。良性肿瘤获随访者16例，失访4例，获随访的16例至今情况良好，最长随访时间9年。恶性淋巴瘤获随访的16例中，4例死亡；1例存活5年，3例生存期已超过5年。结论：原发性脾肿瘤术前定位诊断较易，定性诊断困难。治疗以脾切除术为主，原发性脾恶性淋巴瘤结合化疗时预后相对较好。

Diagnosis and treatment of primary splenic tumors: a report of 39 cases

Objective To summarize the clinical characteristics,diagnosis and treatment of primary,splenic tumors. Methods The clinical data of 39 cases of primary splenic tumor,admitted during the period from January 1996 to Ja- nuary 2007,were analyzed retrospectively.Results Twenty of the 39 cases were benign,including splenic hemagioma (10 cases),splenic cyst(8 cases),splenic lymphangioma(1 case)and splenic hamartoma(1 case),and other 19 were malig- nant tumors,including primary splenic lymphoma(18 cases)and splenic angiosarcoma(1 case).Both uhrasonography and CT scanning could achieve an accuracy of 100% in tumor localization.The accuracy of uhrasonography in diagnosing pri- mary,splenic tumor,splenic cyst,and splenic hemangioma were 12.82%(5/39),50%(4/8)and 10%(1/10)respectively, while those of CT scanning were 32.43%(12/37),83.33%(5/6)and 70%(7/10)respectively.Neither ultrasonography nor CT scanning could determine precisely the nature of the lesions.All the cases underwent operation,which consisted main- ly of splenectomy.All the patients with primary malignant lymphoma received concomitantly adjuvant chemotherapy of the CHOP regimen.Sixteen of the 20 patients with benign neoplasm were still alive.One of them has survived for 9 years. Four of the 16 malignant lymphoma patients with complete follow-up data died during the follow-up.Conclusions Pre- operative localization of the lesion could be easily achieved for primary splenic tumors,but the accurate diagnosis of their nature is not so easy.Splenectomy is the main procedure performed in treating primary splenic tumors.The prognosis of patients with primary malignant lymphoma could be ameliorated after splenectomy by using adjuvant chemotherapy.