原发性脾脏淋巴瘤手术治疗34例分析  

Analysis of 34 Primary Splenic Lymphoma Cases Undergoing Surgical Treatment

作　　者：王毅[1] 宋世铎[1] 刘丰[1] 郭凌川[2] 沈益民[3] 

机构地区：[1]苏州大学附属第一医院普通外科,江苏省苏州市215006 [2]苏州大学附属第一医院病理科,江苏省苏州市215006 [3]苏州大学附属第一医院血液科,江苏省苏州市215006

出　　处：《中国肿瘤临床》2012年第3期153-155,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨原发性脾脏淋巴瘤的外科指征和效果。方法:回顾性分析2002年6月至2010年12月原发性脾脏淋巴瘤34例临床资料。结果:左上腹痛、腹胀13例(38.2%)及B症状5例(14.7%)为原发性脾脏淋巴瘤的主要临床症状。中度及中度以上脾肿大30例(88.2%),Ahmann临床分期Ⅰ期12例(35.3%),Ⅱ期3例(8,8%),Ⅲ期19例(55.9%)。外科手术明确诊断者为12例(35.3%),缓解脾肿大或脾功能亢进症状者为11例(32.4%)。手术方式为29例(85.3%)开腹脾切除术,5例(14.7%)腹腔镜或手助式腹腔镜脾脏切除术。病理为非霍奇金淋巴瘤33例(97.1%),其中B淋巴瘤29例、T淋巴瘤4例。另1例为霍奇金病。术后发生9例(26.5%)并发症,手术死亡4例(11.8%)。结论:脾脏切除术能提高Ⅰ、Ⅱ期原发性脾脏淋巴瘤的生存率,同时能减轻脾肿大引起的不适症状,且有益于进一步明确诊断,腹腔镜或手助式腹腔镜脾切除术有利于原发性脾脏淋巴瘤术后全身情况的恢复。Objective： The current work aims to investigate the surgical indication and curative effect of surgery on primary splenic lymphoma. Methods： The clinical data of 34 cases with primary splenic lymphoma treated at The First Affiliated Hospital of Soochow University from January 2002 to December 2010 were analyzed in retrospect. Results： Left upper abdominal pain and abdominal distension （ 13 cases, 38.2% ）, and B symptoms （ 5 cases, 14.7% ） were the main clinical symptoms of the primary splenic lymphoma. A total of 30 cases suffered moderate to high degrees （ 88.2% ） of splenomegaly. Based on the Ahmann clinical staging of splenic lymphoma, the stage I disease accounted for 11 of the patients （ 32.4% ）, stage I/ accounted for 3 （ 8.8% ）, and stage 1 accounted for 19 （ 55.9% ）. There was a definite diagnosis in 12 of the cases after surgery （ 35.3% ）. The splenomegaly or hypersplenism was relieved in 11 of the cases （ 32.4% ）. Open splenectomy was conducted in 29 cases （ 85.3% ） and laparoscopic or hand-assisted laparoscopy-supported splenectomy was conducted in 5 cases （ 14.7% ）. Histopathology showed that non-Hodgkin lymphoma accounted for 33 of the cases （ 97.1% ）, of which 29 were B-cell lymphoma and 4 were T-cell lymphoma. One case was Hodgkin＇s disease. Postoperative complications occurred in 9 of the cases （ 26.5% ）, with an incidence of death in 4 cases （ 11.8% ）. Conclusion： Splenectomy improves the survival rate of stage Ⅰ / Ⅱ primary splenic lymphoma and relieves the splenomegaly. Moreover, splenectomy could be used for further diagnosis. Laparoscopic splenectomy or hand-assisted laparoscopy is conducive to the recovery of patients with primary splenic lymphoma.

关 键 词：淋巴瘤 脾肿大 脾切除术 腹腔镜 

分 类 号：R733.2[医药卫生—肿瘤]