老年人非霍奇金淋巴瘤合并乳糜胸一例并文献复习  

Chylothorax in non-Hodgkin＇s lymphoma： a case report and review

作　　者：丁勇[1] 王洪冰[1] 柯会星[1] 孙铁英[1] 杨重庆[2] 

机构地区：[1]卫生部北京医院呼吸内科,100730 [2]卫生部北京医院病理科,100730

出　　处：《中华老年医学杂志》2012年第3期229-232,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨乳糜胸的诊断及非霍奇金淋巴瘤乳糜胸的治疗，提高临床对真、假性乳糜胸的认识。方法报告并分析我院诊治的经淋巴结活检确诊为非霍奇金淋巴瘤（NHL）的1例老年非创伤性乳糜胸患者临床资料，并复习国内外相关文献，分析NHL乳糜胸的可能机制并总结其诊治与预后。结果83岁老年男性患者1例，始为单侧乳糜胸，后进展为双侧，约1年病史。明确病因困难，正电子发射断层成像术／计算机断层成像术（PET／CT）检查示胸内及右侧颈部淋巴结代谢活性增高并肿大，行颈部淋巴结活检确诊为弥漫大B细胞型NHL。检索国内外文献中19例NHL乳糜胸患者，采取的治疗方法有6例行放射治疗放疗均有效；11例行化学治疗（化疗），其中6例有效；1例行胸导管结扎术有效；1例行胸导管结扎加药物胸膜固定有效。该例患者拒绝化疗或放疗，行饮食疗法19个月后死亡。结论PET／CT有助于早期发现乳糜胸的隐匿病因。目前尚无标准的NHL乳糜胸治疗方法，应采取个体化治疗。NHL乳糜胸整体预后与非霍奇金淋巴瘤预后相似，要重视早期诊断、综合治疗以延长患者生存时间。Objective To explore the diagnosis and treatment of non-traumatic chylothorax in non-Hodgkin＇s lymphoma （NHL） and to understand the differences in diagnosis and treatment between chylothorax and pseudochylothorax. Methods The patient aged 83 years was confrimed as chylothorax and NHL after lymph node biopsy. We reviewed literatures about chylothorax in NHL to analyse the possible mechanism, its diagnosis and treatment. Results The patient was sufferring from unilateral ehylothorax diagnosed as true chylothorax by thoracentesis, and progressed to bilateral chylothorax after 1 year. PET/CT examination showed intrathoracic and right cervical lymph nodes enlargement and an increasing metabolic activity. Cervical lymph node biopsy revealed diffuse large B cell type non-Hodgkin＇s lymphoma. The patient refused any other treatment except the diet therapy and died after 19 months. We searched 19 cases with NHL chylothorax in associated literatures about the treatments including radiotherapy （6/6 improved）, chemotherapy （6/11 improved）, thoracic duct ligation （1/1 improved） , thoracic duct ligation and drug pleurodesis（1/1 improved）. Conclusions PET/CT is useful in finding the hidden clues of chylothorax in NHL. There is no standard mangement for NHL chylothorax and the treatment must be individualized. The overall prognosis of NHL chylothorax is similar to that of non-Hodgkin＇s lymphoma and the patient needs early diagnosis and general treatment in order to prolong the survival time.

关 键 词：乳糜胸 淋巴瘤 大B细胞 弥漫性 

分 类 号：R733.1[医药卫生—肿瘤]