脾脏转移性肿瘤

　　转移性脾肿瘤的原发灶可以是全身各个器官，来自血行播散的以肺癌、乳腺癌、卵巢癌、前列腺癌、大肠癌、胃癌、肾癌、子宫颈癌、绒毛膜上皮癌及恶性黑色素瘤较为多见，淋巴途径的以腹腔脏器常见，常伴腹主动脉旁或脾周淋巴结肿大。通常，肿瘤脾转移可作为全身转移的一部分，少数情况下可作为乳腺癌、卵巢癌等原发病灶的惟一继发转移性器官。

　　少数脾脏转移性肿瘤患者可伴继发性脾功能亢进、溶血性贫血、胸腔积液，也有少数病例因自发性脾破裂而致出血性休克。

　　1、脾功能亢进简称脾亢，指各种原因造成的伴随脾脏肿大及血细胞过度消耗的临床综合症。

　　2、溶血性贫血是一个良性疾病，系指红细胞破坏加速，而骨髓造血功能代偿不足时发生的一类贫血。

　　3. The pleural cavity is a potential space between the visceral and parietal pleurae. Normally, the pleural cavity contains a small amount of lubricating fluid, which is produced and absorbed in a dynamic balance. When pathological reasons cause an increase in production and/or a decrease in absorption, pleural effusion may occur. Pleural effusion is divided into transudative and exudative effusions.

　　Generally, when cancer patients have liver metastasis, they usually have widespread organ metastasis. Liver metastatic cancer usually does not cause massive splenomegaly, and the spleen only slightly increases in size, or can be completely normal. Therefore, there are often no specific symptoms in clinical practice, and symptoms such as left upper quadrant mass, abdominal pain, and compression of surrounding organs may occur only when the spleen is significantly enlarged. Similarly, symptoms such as fever, loss of appetite, weight loss, anemia, and ascites may also occur.

　　Patients with metastatic liver tumors should first develop good living habits, quit smoking, and limit alcohol consumption. Smoking, as predicted by the World Health Organization, if people stop smoking, the world's cancer rate will decrease by one-third in 5 years; secondly, do not drink excessively. Cigarettes and alcohol are highly acidic substances, and people who smoke and drink for a long time are prone to acidic体质.

　　Secondly, do not eat too much salty and spicy food, do not eat overheated, cold, expired, and deteriorated food; for the elderly, the weak, or those with certain disease genetic predispositions, eat some cancer-preventive foods and alkaline foods with high alkaline content appropriately, and maintain a good mental state.

　　Patients with metastatic liver tumors usually have a history of tumor and are often accompanied by symptoms of advanced malignant tumors such as weight loss, fatigue, low fever, and anemia. A few patients may have discomfort or pain in the upper left abdomen, so patients with this disease can be diagnosed by the following examination methods:

　　One. CT and MRI manifestations

　　1. CT scans of metastatic liver tumors show the liver to be of normal size or slightly to moderately enlarged, with low-density areas within the spleen, with clear or unclear contoural lesions of varying sizes and quantities. The average CT value on plain scan is 25Hu, and it can also present as a cystic change. A few metastatic foci may show isodensity and cannot be detected on plain scan, but they appear as lesions with slightly lower density than normal spleen parenchyma after contrast enhancement. There have been reports of using slow injection of contrast agent into the celiac artery followed by CT scan during the portal venous phase to show the presence of metastases in the liver or spleen, which has a higher detection rate than intravenous contrast enhancement and can detect lesions as small as 5-10mm in diameter. Most patients with metastatic liver tumors have liver metastases, so liver changes should also be considered during examination.

　　2. Metastatic liver tumors in T1-weighted images show irregular low signal areas, which can be solitary or multiple, with clear edges. In T2-weighted images, the signal intensity increases, and in some cases, due to central necrosis and increased water content, central hyperintensity may appear. In T2-weighted images, high signal may also appear around the tumor due to peritumoral edema. In T1-weighted images, areas of edema and necrosis may appear as lower signal areas within the low signal, such as hemorrhage in metastatic tumors, which may appear as high signal. Liver metastases rarely occur alone and are often associated with liver and lymph node involvement.

　　Secondly, Imaging Examination Methods and Comparison

　　Ultrasonic methods are simple, but the equipment and the operator's experience can affect the display of the focus, and foci with a diameter of more than 10mm can generally be detected. Differentiating whether the focus is solid or cystic is sensitive. In addition, ultrasound can also check whether other abdominal organs are involved, such as the adrenal glands, kidneys, and pelvis. Radioactive tracers can only display occupancy foci with a diameter greater than 20mm, and the morphological display is poor and the定性 is difficult. MRI display of spleen occupancy foci depends on the signal intensity of the spleen and the focus, as well as whether it is diffuse. If there is liquefactive necrosis in the focus, the water content increases, T2 prolongs, and a high signal is produced on the T2-weighted image, while it is sometimes difficult to find on the T1-weighted image. The application of paramagnetic contrast agents can shorten T1 and make the focus easier to display. The choice of imaging examination methods is in the order of ultrasound, CT, MRI, and radioactive tracers. The combined use of the above methods can complement each other and improve the detection rate.

　　There are no special dietary requirements for patients with spleen metastatic tumors, and normal diet is generally sufficient. It is important to ensure a rich and balanced diet. Meet the needs of the human body for normal metabolism, such as calories, proteins, and vitamins. Appropriately increase the intake of vegetables, fruits, lean meat, fish, milk, and soy products. In terms of health care, it is important to relax the mind, build confidence, maintain a good attitude, and actively cooperate with the doctor's treatment.

　　If the metastatic tumor of the spleen is localized to the spleen and the primary tumor has been radically resected or the surgical exploration has found that the primary cancer can be radically resected, splenectomy can be performed, and comprehensive treatment is given postoperatively, the effect is still good. When the primary focus has widespread metastasis throughout the body, or there are multiple metastases inside and outside the abdomen, although the spleen metastasis focus can be resected, it is not necessary to perform surgery on the spleen again. When the metastatic spleen tumor spontaneously ruptures, emergency surgery should be performed, and splenectomy should be performed to control bleeding. If the tumor ruptures, regardless of whether the primary focus is radical or whether there is metastasis throughout the body, the surgery belongs to palliative treatment.