Wu Hao M, Kortbeek John B
Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Am J Surg. 2006 May;191(5):631-4. doi: 10.1016/j.amjsurg.2006.01.034.
Post-traumatic splenic pseudocysts are uncommon. The optimal treatment is not well defined.
A retrospective chart review was conducted at the three adult hospitals in the Calgary Health Region.
Six cases of splenic pseudocysts were found over a 6-year period. One splenic pseudocyst spontaneously resolved. A second splenic cyst was removed by open splenectomy. The remaining 4 patients were all first treated with percutaneous drainage. However, 3 of the 4 cysts recurred. Two of these 3 recurrent cysts were treated with laparoscopic fenestration, and all subsequently recurred; 1 of these patients later developed a splenic abscess. The third patient had a repeat percutaneous drain with subsequent recurrence. The last patient died of sepsis secondary to an iatrogenic punctured colon.
Percutaneous drainage and laparoscopic fenestration have an unacceptably high rate of failure. Partial or complete splenectomy should be considered for young and otherwise healthy patients who have large symptomatic splenic pseudocysts.
创伤后脾假性囊肿并不常见。最佳治疗方法尚未明确界定。
在卡尔加里健康区域的三家成人医院进行了一项回顾性病历审查。
在6年期间发现了6例脾假性囊肿。1例脾假性囊肿自行消退。第2例脾囊肿通过开放性脾切除术切除。其余4例患者均首先接受经皮引流治疗。然而，4个囊肿中有3个复发。这3个复发性囊肿中的2个接受了腹腔镜开窗术治疗，随后均复发；这2例患者中有1例后来发生了脾脓肿。第3例患者再次进行经皮引流，随后复发。最后1例患者死于医源性结肠穿孔继发的败血症。
经皮引流和腹腔镜开窗术的失败率高得令人难以接受。对于有大型有症状脾假性囊肿的年轻且其他方面健康的患者，应考虑行部分或全脾切除术。
