Tsakayannis D E, Mitchell K, Kozakewich H P, Shamberger R C
Department of Surgery, Children's Hospital, Boston, MA 02115, USA.
J Pediatr Surg. 1995 Oct;30(10):1468-70. doi: 10.1016/0022-3468(95)90409-3.
Splenic epidermoid cysts are a rare entity. The traditional treatment was splenectomy, performed to prevent infection, hemorrhage, or rupture of the cyst. The authors reviewed their series of 19 children with congenital splenic cysts from 1914 to 1993 to assess the change in management of these lesions. The age of time of presentation ranged from newborn to 17 years (median, 12.0 years) The male:female ratio was 1.0:1.1. Five cysts were found incidentally at the time of autopsy. The cysts were 0.5 to 24 cm in diameter (median, 12.0 cm). Only cysts greater than 8 cm presented with clinical symptoms: 64% with an abdominal mass and/or 78% with abdominal pain. One patient presented with a left varicocele. There were no complications related to the cysts. A variety of radiographic studies were performed, but ultrasonography provided all required diagnostic information. All patients treated before 1971 (n = 9) underwent splenectomy, and five patients treated since 1983 had hemisplenectomy or cystectomy. Postoperative spleen scans (obtained in three of these patients) and platelet counts showed preservation of splenic function. Pathological examination showed epidermoid cysts in all cases. There were no postoperative complications. In conclusion, in this series of epidermoid splenic cysts in children, (1) the cysts presented with an abdominal mass and/or abdominal pain only if they were greater than 8 cm in size, and there were no complications owing to the cysts; (2) ultrasonography was the most cost-effective and least invasive method of evaluation; and (3) splenic preservation by hemisplenectomy or cystectomy, used to avoid the long-term risks of splenectomy, proved to be a safe, easy procedure, with maintenance of splenic function.
脾表皮样囊肿是一种罕见的疾病。传统的治疗方法是脾切除术，目的是预防囊肿感染、出血或破裂。作者回顾了他们从1914年至1993年收治的19例先天性脾囊肿患儿的病例系列，以评估这些病变治疗方式的变化。发病年龄从新生儿到17岁（中位数为12.0岁），男女比例为1.0:1.1。5例囊肿是在尸检时偶然发现的。囊肿直径为0.5至24厘米（中位数为12.0厘米）。只有直径大于8厘米的囊肿出现临床症状：64%有腹部肿块和/或78%有腹痛。1例患者出现左侧精索静脉曲张。未出现与囊肿相关的并发症。进行了多种影像学检查，但超声检查提供了所有所需的诊断信息。1971年以前接受治疗的所有患者（n = 9）均接受了脾切除术，1983年以后接受治疗的5例患者进行了半脾切除术或囊肿切除术。术后脾脏扫描（其中3例患者进行了此项检查）和血小板计数显示脾功能得以保留。病理检查在所有病例中均显示为表皮样囊肿。未出现术后并发症。总之，在这一系列儿童脾表皮样囊肿病例中，（1）囊肿只有在直径大于8厘米时才会出现腹部肿块和/或腹痛，且未出现因囊肿引起的并发症；（2）超声检查是最具成本效益且侵入性最小的评估方法；（3）通过半脾切除术或囊肿切除术保留脾脏以避免脾切除术的长期风险，事实证明这是一种安全、简便的手术，且能维持脾功能。
