胸部恶性淋巴瘤的诊断及手术疗效观察(附22例报告)  

Diagnosis and surgical treatment of thoracic malignant lymphoma:a report for 22 cases

作　　者：梁涛[1] 杨学亮[1] 刘阳[1] 

机构地区：[1]解放军总医院胸外科,北京100853

出　　处：《解放军医学杂志》2008年第4期447-449,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨胸部恶性淋巴瘤的临床特点、诊断方法及外科手术疗效。方法对22例胸部恶性淋巴瘤患者的临床资料进行回顾性分析,其中16例为非霍奇金淋巴瘤（12例B细胞性、4例T细胞性）,6例为霍奇金病（5例结节硬化型、1例混合细胞性）。肿瘤多数位于前中上纵隔,其中2例侵及左上肺,2例侵及右上肺。临床症状多为咳嗽、咳痰、胸闷、胸痛,偶伴发热、咯血等。所有患者均接受手术治疗,术后病理与术前穿刺病理及依据影像学表现所做诊断均不符,术后治疗包括化学治疗、放射治疗、自体造血干细胞移植等。结果随访时间1-112个月,平均13.8个月,14例非霍奇金淋巴瘤（Ⅰ期2例,Ⅱ期4例,Ⅲ期3例,Ⅳ期5例）术后已存活1-112个月,6例霍奇金病患者（Ⅰ期2例,Ⅱ期1例,Ⅲ期1例,Ⅳ期2例）已存活3-46个月,2例非霍奇金淋巴瘤分别于术后18和35个月死亡。结论胸部恶性淋巴瘤缺乏特异性表现,准确诊断较困难,外科手术干预对其诊治有积极意义。术后应选择包括放射治疗、正规化疗及免疫治疗在内的综合治疗手段。Objective To study the clinical features, diagnosis and surgical treatment of thoracic malignant lymphoma. Methods Clinical data of 22 patients with malignant lymphoma were retrospectively analyzed. Among them 16 were classified as non-Hodgkin＇s lymphoma （B cell lymphoma 12 cases and T cell lymphoma 4 cases）, and 6 were classified as Hodgkin＇s lymphoma （nodular sclerosing lymphoma 5 cases and 1 case of mixed cellularity type lymphoma）. Most of the tumors were located in anterior mediastinum or middle superior mediastinum, and 2 of the tumors located in upper left lung, another 2 located in upper right lung. Cough, stethocatharsis, chest distress and chest pain were the main clinical symptoms. Abnormal masses in mediastinum were seen on X ray film, occasionally with changes in lung. Before the operation, 4 cases were misdiagnosed depended on the results of intracranial puncture examination, and the other 18 cases were misdiagnosed as either lung cancer with mediastinal lymph nodes metastasis or thymoma based on the imaging findings. All patients received either total tumor resection or partial excision. After the operation, 16 cases with non-Hodgkins lymphoma received CHOP chemotherapy （2 cases received radiotherapy and 2 cases received autologous hematopoietic stem cell transplantation after chemotherapy）, 6 cases with Hodgkiffs lymphoma received ABVD regimen （2 case received radiotherapy）. Results Fourteen cases with non-Hodgkin＇s lymphoma （2 cases for stage Ⅰ, 4 cases for stage Ⅱ, 3 cases for stage Ⅲ, 5 cases for stage IV） had survived for 1--112 months until the follow-up, 6 cases with Hodgkin＇s lymphoma （2 cases for stage Ⅰ, 1 case for stage Ⅱ, 1 case for stage Ⅲ, 2 cases for stage Ⅳ） had survived for 3--46 months. Two cases with non-Hodgkin＇s lymphoma died 18 and 35 months after operation, respectively. Conclusions The preoperative diagnosis to thoracic malignant lymphoma is difficult for the special clinical features limited. Surgical excision is important for

关 键 词：淋巴瘤 胸部肿瘤 诊断 治疗结果 

分 类 号：R734[医药卫生—肿瘤]