68例原发性小肠淋巴瘤的临床分析  

Primary small intestinal lymphoma： a clinical analysis of 68 cases

作　　者：张辉[1] 张汝鹏[1] 李昉璇[1] 刘辉[1] 权继传[1] 梁寒[1] 

机构地区：[1]天津医科大学附属肿瘤医院胃部肿瘤科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室,300060

出　　处：《中华消化外科杂志》2014年第5期336-340,共5页Chinese Journal of Digestive Surgery

基　　金：国家重点基础研究发展计划（973计划）项目（2010CB529301）

摘　　要：目的探讨原发性小肠淋巴瘤（PSIL）的临床病理特征、治疗方式及影响预后的因素。方法回顾性分析1999年11月至2009年7月天津医科大学附属肿瘤医院收治的68例原发性小肠淋巴瘤患者的临床资料。患者术前分别行腹部B超、CT、消化道钡剂造影、内镜及实验室检查。区域性小肠淋巴瘤行根治性切除，无法根治者行姑息治疗，术后根据Ann—Arbor分期法进行精确分期，并根据病情施行化疗。采用书信、电话与门诊复查相结合的方式对患者进行随访，随访时间截至2012年7月。采用Kaplan—Meier法绘制生存曲线，生存率比较采用Log—rank检验，单因素分析采用Log—rank检验，多因素分析采用COX回归模型。结果68例PSIL患者中临床表现为腹痛47例、体质量减轻20例，腹胀等。68例患者术前均行消化道钡剂造影和内镜检查，分别确诊15例和11例；45例行B超检查，38例发现腹腔包块；30例行CT检查，5例行PET．CT检查均明确诊断为小肠肿瘤。68例PSIL患者中肿瘤位于回肠50例、空肠13例、十二指肠5例。病理检查：B细胞淋巴瘤64例，T细胞淋巴瘤4例；肿瘤分期多为I期和Ⅱ期，占总例数的66．2％（45／68）。68例患者均接受了手术治疗，其中行根治性切除术51例、姑息手术17例。术后57例施行4～8个疗程辅助化疗，其中施行COP方案7例、施行CHOP方案50例（包括10例CD20阳性患者同时施行利妥昔单抗治疗）；其余11例患者未施行化疗。64例患者术后获得随访，随访率为94．1％（64／68），中位随访时间为40个月（3～132个月），患者中位生存时间为40．5个月，术后1、3、5年总体生存率分别为78．1％、62．2％和59．7％。肿瘤病理分型为B细胞淋巴瘤，肿瘤分期为I～Ⅱ期和手术联合化疗患者预后分别优于T细胞淋巴瘤、Ⅲ～Ⅳ期和单纯手术治疗患者，差异有统计学意义（X2=22．459，45．535，15�Objective To investigate the clinicopathological characteristics, treatment, prognostic factors of primary small intestinal lymphoma （PSIL）. Methods The clinical data of 68 patients with PSIL who were admitted to the Cancer Hospital of Tianjin Medical University from November 1999 to July 2009 were retro- spectively analyzed. The diagnostic workup before operation included abdominal ultrasound, computed tomography （CT） scan of the abdomen, small intestinal barium radiography, endoscopy examination and laboratory examination. The patients with local PSIL underwent radical surgery, patients who were not eligible for radical surgery received palliative treatment, and then accurate staging was done according to Ann-Arbor system for gastrointestinal lymphoma, and chemotherapy was applied according to the condition of patients. The patients were followed up by letters, telephone and outpatient care till July 2012. Factors might have influence on the prognosis were analyzed by the Kaplan-Meier method and Log-rank test. COX regression model were used for univariate andmultivariate analysis, respectively. Results The major symptoms of PSIL included abdominal pain （69. 1%, 47/68） and weight loss （ 29.4%, 20/68 ）. All of the 68 patients underwent small intestinal barium radiography and endoscopy examination, and 15 and 11 cases were definitely diagnosed as with PSIL. Abdominal mass were detected by abdominal ultrasound in 38 of 45 cases. Positive results were found in 30 cases by CT and 5 cases by positron emission tomography （PET）-CT. PSIL mainly involved ileum （73.5%, 50/68）, 13 PSILs were located at the jejunum and 5 at the duodenum. Of all the 68 patients, 64 were with B-cell subtype PSIL and 4 were with T-cell subtype PSIL. Most tumors belonged to stages I and I1 （66.2%, 45/68）. All of the 68 patients were treated with surgical procedure, including 51 patients received radical resection and 17 patients had palliative resection. After operation, 4-8 cycles of chemotherapy were applied in 57 p

关 键 词：小肠肿瘤 淋巴瘤 非霍奇金 治疗 预后 

分 类 号：R735.32[医药卫生—肿瘤]