儿童成熟B细胞非霍奇金淋巴瘤合并消化道穿孔的临床特征及预后  

Clinical features and outcomes of digestive tract perforation in pediatric mature B-cell non-Hodgkin lymphoma

作　　者：杨雪良 刘婷婷[2] 王晓曼[3] 吕传凯[3] 金玲[1] 杨菁[1] 黄爽[1] 张梦[1] 李楠[1] 严佳虞 段彦龙[1] Yang Xueliang;Liu Tingting;Wang Xiaoman;Lyu Chuankai;Jin Ling;Yang Jing;Huang Shuang;Zhang Meng;Li Nan;Yan Jiayu;Duan Yanlong(Mepartment of Medical Oncology,Pediatric Oncology Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing Key Laboratory of Pediatric Hematology Oncology,National Key Clinical Discipline of Pediatric Oncology,Key Laboratory of Major Diseases in Children,Ministry of Education,Beijing 100045,China;Department of Emergency Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Department of Ultrasound,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Department of General Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家医学儿童中心,首都医科大学附属北京儿童医院儿童肿瘤中心肿瘤内科,儿童血液病与肿瘤分子分型北京市重点实验室,儿童肿瘤国家临床重点专科,儿科重大疾病研究教育部重点实验室,北京100045 [2]国家医学儿童中心,首都医科大学附属北京儿童医院急诊外科,北京100045 [3]国家医学儿童中心,首都医科大学附属北京儿童医院超声科,北京100045 [4]国家医学儿童中心,首都医科大学附属北京儿童医院普外科,北京100045

出　　处：《中华医学杂志》2024年第27期2568-2571,共4页National Medical Journal of China

摘　　要：总结儿童成熟B细胞非霍奇金淋巴瘤(mB-NHL)合并消化道穿孔的临床特点和预后。回顾性分析2016年1月至2023年6月首都医科大学附属北京儿童医院收治的合并消化道穿孔的mB-NHL患儿的临床表现、实验室及影像学检查、治疗及转归。共纳入12例患儿,男11例,女1例,年龄0.8~16.0(7.5±5.4)岁。其中,伯基特淋巴瘤10例,高级别B细胞淋巴瘤(HGBL)和弥漫大B细胞淋巴瘤(DLBCL)各1例。所有患儿均存在肠道受累,St.Jude分期为Ⅲ~Ⅳ期,11例患儿均存在腹腔巨大包块;7例患儿消化道穿孔时全腹立位X片提示膈下游离气体;11例患儿于化疗后出现消化道穿孔,穿孔距离首次化疗时间为2.0~111.0(41.2±33.6)d;穿孔好发部位依次为回肠(6例)、胃壁(2例)、空肠(1例)、结肠(1例)、阑尾(1例)。8例患儿行手术治疗,术后距离再次化疗的时间为7.0~45.0(17.6±12.0)d。1例化疗前穿孔患儿放弃治疗后死亡;余11例患儿予保守治疗或外科手术干预,症状及感染控制后给予规律化疗,随访时间6.0~82.0(45.0±26.1)个月,均存活。To summarize the clinical features and prognosis of pediatric mature B-cell non-Hodgkin lymphoma(mB-NHL)with digestive tract perforation.The clinical manifestations,laboratory and imaging examinations,treatment and outcomes of mB-NHL children complicated with digestive tract perforation admitted to Beijing Children's Hospital of Capital Medical University from January 2016 to June 2023 were retrospectively analyzed.A total of 12 patients were included,with 11 males and 1 female,aged 0.8-16.0(7.5±5.4)years.Among them,there were 10 cases of Burkitt lymphoma,1 case of high-grade B-cell lymphoma(HGBL)and 1 case of diffuse large B-cell lymphoma(DLBCL),respectively.Intestinal involvement was involved in all cases,with St.Jude staging ranging from stageⅢtoⅣ.Eleven cases had large abdominal mass.In 7 cases,abdominal X-ray examination showed free gas under the diaphragm.Eleven cases experienced digestive tract perforation after chemotherapy,and the time of perforation after initiation of chemotherapy was 2.0-111.0(41.2±33.6)days.The most common site of perforation was ileum(6 cases),followed by gastric wall(2 cases),jejunum(1 case),colon(1 case)and appendix(1 case).Eight patients underwent surgery,and the time between surgery and re-chemotherapy was 7.0-45.0(17.6±12.0)days.One case with perforation before chemotherapy died after giving up treatment.The remaining 11 cases received conservative treatment or surgical intervention,followed by regular chemotherapy after symptom and infection control.The follow-up time was 6.0-82.0(45.0±26.1)months,and all survived.

关 键 词：淋巴瘤 B细胞 肠穿孔 儿童 预后 

分 类 号：R733.1[医药卫生—肿瘤] R726.5[医药卫生—临床医学]