Spleen tumor

　　The spleen is composed of connective tissue支架, lymphatic tissue, blood vessels and lymphatic vessels, as well as cells of the hematopoietic and mononuclear-macrophage systems. The spleen is divided into two parts: the white pulp and the red pulp, with a transitional zone in between, known as the marginal zone, which is the area where the red pulp receives arterial blood. The white pulp is composed of dense lymphatic tissue and is the main distribution area for T lymphocytes, similar in structure to lymphatic follicles but with a rich blood circulation. The small arteries branching from the trabecular artery have a large number of lymphatic nodules around them, known as the central artery of the lymph sheath. The lymph sheath contains a dense population of lymphocytes and plasma cells. The central artery and its branching small arteries are vertically positioned, so most of the branching small arteries contain plasma with very few blood cells, which is beneficial for the spleen to exert its immune function. Antigenic substances in the blood directly contact the lymphocytes and plasma cells within the lymph sheath through the branching small arteries and capillaries, stimulating the generation of more immune-active cells. Due to antigen stimulation, germinal centers can appear in the white pulp, containing differentiated and proliferating B cells that can produce corresponding antibodies.

　　In addition to the complications after general abdominal surgery, splenic tumors also require special attention to the following complications:

　　2. Intraperitoneal massive hemorrhage Generally occurs within 24-48 hours after surgery. Common causes include severe hemorrhage from the splenic fossa wound, the ligation line of the splenic pedicle falling off, or bleeding from vessels missed during surgery. In cases where a large amount of bleeding occurs within a short period of time, and hypotension or shock occurs, the patient should be operated on again immediately to stop bleeding. Paying attention to correcting possible coagulation disorders before surgery, and strict hemostasis during surgery is the key to preventing such complications.

　　1. Subphrenic infection Strict hemostasis during surgery, avoiding injury to the tail of the pancreas, and effective drainage under the diaphragm after surgery are effective preventive measures.

　　2. Thromboembolic complications are not common. However, if it occurs in the retinal artery, mesenteric vein, or main portal vein, it can cause serious consequences. It is generally believed that its occurrence is related to a sudden increase in platelets after splenectomy, so it is generally advocated that the platelet count after surgery should be greater than 1000×10⁹Heparin and other anticoagulants should be used for prophylactic treatment when /L is applied. The severe infection (OPSI) after splenectomy is a special problem in the long-term period after splenectomy. After splenectomy, the body's immune function is weakened and the ability to resist infection decreases, not only increasing susceptibility but also the occurrence of OPSI, mainly in infants and young children. Therefore, for patients with splenic injury and certain splenic diseases who have indications for partial splenectomy or partial splenic artery embolization, these treatments should be considered. The clinical characteristics of OPSI are insidious onset, with mild common cold-like symptoms at the beginning. The onset is sudden, with a fierce onset, with sudden chills, high fever, headache, nausea, vomiting, diarrhea, and even coma and shock, often complicated with disseminated intravascular coagulation. Although the incidence of OPSI is not high, the mortality rate is high. 50% of patients have pneumococcus as the pathogen. Treatment should be started early with high-dose antibiotics and maintaining the function of vital organs.

　　Clinical symptoms of splenic tumors include:

　　1. Most cases of splenic enlargement are accompanied by discomfort, pain, and compression symptoms in the upper left abdomen, such as abdominal distension, nausea, constipation, and respiratory distress.

　　2. Hyperplasia of the spleen is related to splenic enlargement, but the symptoms are not proportional to the degree of splenic enlargement. For inexplicable hyperplasia of the spleen accompanied by splenic enlargement, it should be highly suspected that a tumor exists, especially a hemangioma.

　　3. General symptoms are often seen in malignant tumors of the spleen, manifested as low fever, anemia, fatigue, general discomfort, weight loss, cachexia, and so on.

　　4. Spontaneous rupture of splenic tumors is rare in clinical practice, presenting as sudden abdominal pain, peritonitis, and can lead to hemorrhagic shock and even death. If splenic rupture is accompanied by early metastasis, it is the worst prognostic factor. Spontaneous splenic rupture may be secondary to hemophagocytic syndrome, angioendothelioma, multiple vascular tumors of the serosa, T-cell leukemia, and so on. Some may be accompanied by peritoneal metastasis, more common in spontaneous rupture of splenic hemangioma and angiosarcoma.

　　Active prevention of liver cirrhosis caused by various etiologies (especially schistosomiasis cirrhosis), chronic infections such as malaria, tuberculosis, malignant tumors such as lymphoma, chronic lymphocytic leukemia, myelofibrosis, and chronic hemolytic anemia, as well as rare reticuloendothelial cell disease, is meaningful for the prevention of splenic tumors.

　　The examination of splenic tumors mainly includes ultrasound examination and blood examination, as follows:

　　1. Ultrasound examination:Almost all cases have an enlarged spleen. However, the enlargement of the spleen is not necessarily proportional to the degree of splenic hyperactivity. For those who cannot feel the spleen under the ribs, further examination should be conducted to confirm whether it is enlarged. Scanning of the spleen area after injection of 99mTc, 198Au, or 113mIn colloids can help estimate the size and shape of the spleen. Computerized tomography can also determine the size of the spleen and the lesions inside the spleen.

　　2. Peripheral blood examination:Red blood cells, white blood cells, or platelets in peripheral blood can decrease alone or simultaneously. Generally, in early cases, only white blood cells or platelets decrease, while in late cases, there is a decrease in all blood cells. The decrease in blood cells is not proportional to the enlargement of the spleen.

　　Patients with splenic tumors should eat nutritious, easy-to-digest, neutral-flavored foods. The diet of patients should be light and easy to digest, with more fruits and vegetables, a reasonable diet, and attention to adequate nutrition. In addition, patients should also pay attention to avoid spicy, greasy, and cold foods.

　　If diagnosed with splenic tumor, the removal of the spleen and X-ray radiation therapy cannot relieve the primary disease that causes splenic hyperactivity, so it is generally recommended to treat the primary disease first. If there is no effect, then actively treat the primary disease after spleen removal.