原发性胃恶性淋巴瘤的临床、内镜和病理特征24例  

Clinicopathologic and endoscopic characteristics of primary gastric malignant lymphoma:an analysis of 24 cases

作　　者：汪佩文[1] 姜海琼[1] 吴坚炯[1] 

机构地区：[1]上海交通大学附属第一人民医院消化科,上海市200080

出　　处：《世界华人消化杂志》2010年第31期3352-3355,共4页World Chinese Journal of Digestology

摘　　要：目的:总结原发性胃恶性淋巴瘤(PGML)的临床、胃镜和病理特征以提高临床医师对PGML的诊治水平.方法:分析2003-01/2008-12交通大学附属第一人民医院收集的24例PGML患者的临床资料、胃镜特点、辅助检查、病理结果和治疗方法.结果:本组病例临床表现无特异性,有上腹痛,上消化道出血,纳差、消瘦等.24例胃镜检查的表现多样化,可有巨大、多发溃疡、多发糜烂、胃增殖灶、胃、十二指肠多发溃疡和疑似胃癌.PGML肿瘤好发部位以胃体为主,其次为胃窦、窦交界.胃镜活检确诊率62.5%,幽门螺杆菌(H.pylori)阳性率40%,19例行手术联合化疗,3例仅做化疗,本组24例均为B细胞非霍奇金淋巴瘤.结论:PGML术前确诊不易,易漏诊,需多次、多部位、深部大块活检,结合超声胃镜可提高确诊率,治疗应行根治术,术后辅以化疗,H.pylori阳性者予抗H.pylori治疗.AIM：To summarize the clinical,endoscopic and pathologic characteristics of primary gastric malignant lymphoma（PGML） to improve early diagnosis and facilitate prompt treatment of the disease.METHODS：The clinicopathologic and endoscopic data for 24 PGML patients were reviewed and analyzed to summarize the clinicopathologic and endoscopic characteristics of the disease.RESULTS：Upper abdominal pain,upper gastrointestinal bleeding,decreased appetite and emaciation were common but nonspecifi c clinical symptoms in PGML patients.Gastroscopic manifestations were diverse,including multiple large gastric ulcers,multiple erosions,multiple gastroduodenal ulcers,proliferative foci,and manifestations mimicking gastric cancer.The preferential sites of PGML were gastric body,antrum,and corpus-antral junction.Biopsy yielded a diagnostic rate of 62.5%,while the rate of Helicobacter pylori（H.pylori） infection was 40%.Nineteen patients underwent surgery with subsequent chemotherapy,whereas three patients underwent chemotherapy alone.All 24 cases belonged to B-cell non-Hodgkin＇s lymphoma.CONCLUSION：Preoperative diagnosis of PGML is diffi cult.Multiple gastroscopic examinations,multiple biopsy sites and large samples are necessary for clear diagnosis.Radical surgery with subsequent chemotherapy is preferred.H.pylori infection should be eradicated in patients with PGML.

关 键 词：原发性胃恶性淋巴瘤 胃镜 活检病理 手术 化疗 

分 类 号：R735.2[医药卫生—肿瘤]