Hand-Assisted Laparoscopic Splenectomy for Idiopathic Splenic Infarction: Report of a Case

經手輔助腹腔鏡處理原發性脾臟梗塞：病例報告

陳榮堅(Jung-Chien Chen) ； 林鉷彬(Hung-Bun Lam) ； 劉建良(Chien-Liang Liu)

《Formosan Journal of Surgery》 38卷6期 (2005/12) Pp. 285-288

https://doi.org/10.29833/FJS.200512.0004

摘要

脾臟梗塞是一種少見的疾病。患者於病程初期多僅有腹痛，發燒等非特異性症狀，因而增加診斷的困難。這些患者大都具備某些導致血栓或改變血行動力的致病因素，少有不明原因（原發性）的脾臟梗塞。
一位四十歲男性病患，因發燒及腹痛至本院急診。經腹部超音波及電腦斷層診斷為脾臟梗塞。血球及血清檢查皆正常，血液細菌培養無異常發現，僅出現脾臟梗塞後引起的正常血球型態貧血之生理現象。我們先給予積極性保守治療，但症狀持續惡化，核磁共震掃瞄發現梗塞範圍擴大。此後患者接受小型開腹傷口建立單手進入腹腔管道所完成的經手輔助腹腔鏡脾臟摘除手術，病理報告為脾臟梗塞及組織壞死。我們在整個治療過程中做了各項檢查，探究其脾臟梗塞的致病因素，皆無異常發現。這種不明原因（原發性）的脾臟梗塞，在臨床上甚為罕見。我們回顧了相關文獻並提出病例報告。對脾臟梗塞的發生保持警覺，做出正確的診斷，及採行適時的手術介入，方能使病患得到較佳的預後。

並列摘要

Splenic infarction is an uncommon condition, and it is difficult diagnose the early stage of this disease. Most of these cases have obvious underlying etiologies, and these etiologies may provide the clues to their diagnoses. We present a case of idiopathic splenic infarction. A 40-year-old male was admitted because of fever and chills for 4 days. The abdominal computed tomography (CT) showed splenic infarction. Studies including blood culture, echocardiography and rheumatoid factor, were negative. Medical treatment was given first, but the symptoms did not improve. And the magnetic resonance imaging (MRI) revealed increased infarction areas. After failure of medical treatment, hand-assisted laparoscopic splenectomy was performed. Multiple infarction areas with abscess were seen in the specimen, and the culture of this abscess was negative. The post-operative course was smooth and the patient recovered well. We also review the medical literature. Precise diagnosis with adequate timing of surgical intervention will provide better prognosis for splenic infarction.

並列關鍵字

splenic infarction ； hand-assisted laparoscopic splenectomy