原发性小肠淋巴瘤34例临床病理分析  

Clinicopathological analysis of 34 cases of primary small intestine lymphoma

作　　者：姚君良[1] 倪醒之[1] 沈艳莹[2] 张子臻[1] 肖子理[1] 

机构地区：[1]上海交通大学医学院仁济医院普外科,上海200127 [2]上海交通大学医学院仁济医院病理科,上海200127

出　　处：《上海交通大学学报（医学版）》2009年第5期574-577,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的分析原发性小肠淋巴瘤(PSIL)的临床与病理特征,探讨临床分期、组织学类型和治疗方法等与预后的关系。方法收集34例PSIL的病例资料,通过病理组织学观察和免疫组化检测,结合临床随访资料进行分析。结果34例PSIL患者中,常见症状为腹部疼痛或不适、消化道出血和腹部肿块等;病变部位以回肠最常见,尤其是末端回肠和回盲部。26例随访>1年的PSIL患者中,肿瘤无穿孔者的1年生存率显著高于伴穿孔者(76.2%vs20.0%)(P<0.05);手术联合术后化疗者的1年生存率显著高于单纯手术者(88.2%vs22.2%)(P<0.01);ⅠE/ⅡE期的1年生存率显著高于ⅢE/ⅣE期(100.0%vs43.8%)(P<0.05),ⅠE/ⅡE期的平均生存时间显著长于ⅢE/ⅣE期[(61.8±4.9)月vs(24.8±6.7)月](P<0.05);B细胞淋巴瘤患者的平均生存时间显著长于T细胞淋巴瘤患者[(47.4±6.2)月vs(5.0±3.1)月](P<0.05)。结论PSIL的主要症状为腹部疼痛或不适、消化道出血和腹部包块等,病变部位以回肠多见,临床分期、组织学类型和是否伴有穿孔有助于对本病预后的判断,其治疗以手术切除为主,术后联合化疗有助于提高生存率。Objective To analyse the clinicopathological features of primary small intestine lymphoma （PSIL）, and explore the relationship between clinical stage, histological findings, therapeutic modality and prognosis. Methods The clinical data of 34 cases of PSIL were collected, the pathohistological features and results of immunohistochemical examinations were obtained, and the follow-up findings were adopted for comprehensive analysis. Results Among these 34 cases of PSIL, abdominal pain or discomfort, gastrointestinal bleeding and abdominal mass were the predominant symptoms. PSIL mainly involved ileum, especially the bottom of ileum and ileocecal area. Among the 26 patients with follow-up for more than one year, the 1-year survival rate was significantly higher in patients without tumor perforation than those with tumor perforation （76.2% vs 20.0% ）（P 〈0.05）, while that was significantly higer in patients with chemotherapy after surgery than those without chemotherapy after surgery （88.2% vs 22.2% ） （ P 〈 0.01）. The 1-year survival rate was significantly higher in patients of stage Ⅰ E/Ⅱ E than those of stage ⅢE/ⅣE（ 100.0% vs 43.8%） （P 〈 0.05）, and the mean survival time was significantly longer in patients of stage Ⅰ E/Ⅱ E Ethan those of stage ⅢE/ⅣE[ （61. 8±4. 9） months vs（ 24. 8 ±6. 7） months] （P 〈0.05）. The mean survival time was significantly longer in patients with B-cell lymphoma than those with T-cell lymphoma[ （47.4 ± 6.2） months vs （ 5.0± 3. 1 ） months] （ P 〈 0.05）. Conclusion The main symptoms of PSIL are abdominal pain or discomfort, gastrointestinal bleeding and abdominal mass, the major tumor location is ileum, and clinical stage, histological classification and perforation may help to predict the prognosis of PSIL. Surgery in combination with chemotherapy may improve the survival of PSIL.

关 键 词：原发性小肠淋巴瘤 临床病理特征 预后 

分 类 号：R735.32[医药卫生—肿瘤]