患者男,27岁,因右大腿横纹肌肉瘤术后1年,腹部肿块半月入院.入院前在院外检查示右大腿切口复发及右膝关节转移.查体:腹部膨隆,上腹部可及一约儿头大小肿块,质硬,活动度欠佳.CT检查出腹腔转移性肿瘤.入院后给予DPP、ADM、VDS化疗第3天患者突然感到满腹疼痛、心慌,腹腔穿刺抽出不凝血液,故以腹腔转移性横纹肌肉瘤破裂出血行剖腹探查术,术中见腹腔广泛粘连,位于上腹部有一20cm×25cm大小肿块,将胃推向右侧并与胃大弯粘连;邻近于脾门并与脾脏粘连;包块侵犯胰尾,囊内充满大量暗红色血液及鱼肉样肿瘤组织,张力较高.行转移瘤、脾脏、胰尾切除.术后置潘氏管引流,恢复良好,术后病理示腹腔、脾胰周围转移性胚胎型横纹肌肉瘤.讨论 横纹肌肉瘤来自横纹肌母细胞,男比女多见,各年龄均可发生,可发生于人体各部位,也可发生在没有横纹肌部位.主要分四型:多形型、腺泡型、胚胎型和葡萄型.胚胎型多发生于小儿,它有早期向局部扩散倾向.尸解发现经淋巴结或血液播散到肺、肝.但转移至腹腔、脾脏和胰腺均罕见.本例患者系晚期,姑息性切除破裂出血之转移瘤,延长了患者生命,减轻痛苦. The patient was a 27-year-old man with a right hemifacial rhabdomyosarcoma 1 year after surgery. The abdominal mass was admitted to the hospital for half a year. Before the admission, an extra-hospital examination showed recurrent right thigh incision and right knee joint metastasis. Physical examination: abdominal distention, upper abdominal reachable Size, mass, hard, poor activity. CT examination of abdominal metastatic tumors. DPP, ADM, VDS on the third day after admission to hospital, the patient suddenly felt full of pain, palpitation, abdominal puncture to extract blood, so the abdominal transfer The rhabdomyosarcoma bleeding was performed by laparotomy. During the operation, extensive abdominal adhesions were seen. There was a 20cm×25cm mass in the upper abdomen. The stomach was pushed to the right side and adhered to the greater curvature of the stomach. Adjacent to the splenic portal and adhering to the spleen; The block invaded the tail of the pancreas, and the capsule was filled with a large number of dark red blood and fish-like tumor tissues. The tension was higher. Metastatic tumors, spleen, and pancreatic tail were removed. Postoperative Pan catheter drainage resulted in good recovery. Postoperative pathology showed abdominal cavity and spleen. Peripheral pancreatic metastatic embryonal rhabdomyosarcoma. Discussion Rhabdomyosarcoma comes from rhabdomyosarcoma cells, males are more common than females, can occur in all ages, can occur in various parts of the body, and can also occur in the absence of striated muscle. Mainly divided into four types: more shape Alveolar type, embryo type and grape type. Embryonic type occurs in children, it has an early tendency to spread to the local. Autopsy found by lymph nodes or blood disseminated to the lungs, liver, but the transfer to the abdominal cavity, spleen and pancreas are rare In this patient’s case, the palliative resection of metastatic tumors with ruptured hemorrhage prolonged life and relieved the pain.