未经批准:目前缺乏关于转移性黑色素瘤最佳治疗方案的证据。在单个脾转移的患者中,术前超选择性栓塞后脾部分切除术(PS)可能是一种可行的治疗策略,以保护脾功能,并有望降低术后出血的风险.据我们所知,这种两步法尚未在脾转移患者中发表.
方法:我们介绍了一个73岁的男性,患有IV期黑色素瘤,包括位于下极的单个脾转移。手术前四天,患者接受了经皮超选择性动脉栓塞到下脾极的部分动脉。随后,使用上中线剖腹术进行PS,在断流的下三分之一脾脏中发现了清晰可见的肿瘤。使用能量装置将脾实质分开,并用透热和止血片固定止血。患者恢复简单,术后第8天出院。组织学显示8毫米,黑色素瘤部分坏死转移。在他的最后一次控制术后四个月没有复发的迹象。
UNASSIGNED:没有关于如何切除黑色素瘤的脾转移的指南,也没有任何关于PS术后脾功能或生存率的文献。
结论:超选择性栓塞后PS治疗转移性黑色素瘤可能是高选择性患者的可行治疗方法,因为患者强烈希望保留脾功能。
UNASSIGNED: There is lack of evidence regarding the best treatment option for metastatic melanoma. In patients with a single splenic metastasis, preoperative superselective embolization followed by partial splenectomy (PS) could be a feasible treatment strategy to preserve splenic function and hopefully reduce the risk of postoperative bleeding. To our knowledge, this two-step procedure has yet not been published in patients with splenic metastasis.
METHODS: We present the case of a 73-year-old man with stage IV melanoma consisting of a single splenic metastasis located at the lower pole. Four days prior to surgery, the patient underwent percutaneous superselective embolization of the segmental arteries going to the lower splenic pole. Subsequent, PS was performed using an upper midline laparotomy were a clearly visible tumor was found at the devascularized lower third of the spleen. The splenic parenchyma was divided using an energy device and hemostasis was secured with diathermia and a hemostatic patch. The patient had an uncomplicated recovery and was discharged home on postoperative day 8. Histology revealed an 8 mm, partly necrotic metastasis from a melanoma. There were no signs of recurrency at his last control four months postoperative.
UNASSIGNED: There are no guidelines on how splenic metastasis from melanoma are to be removed, nor any literature on postoperative splenic function or survival after PS.
CONCLUSIONS: Superselective embolization followed by PS for metastatic melanoma could be a feasible treatment approach in highly selective patients where there is a strong desire to preserve splenic function.