儿童原发性胃肠道淋巴瘤20例临床分析  

Clinical features and therapeutic outcomes of primary gastrointestinal lymphoma in children： a report of 20 cases

作　　者：湛玉晓 岳铭[1] 张大[1] 杨合英[1] 姚阳迪 王家祥[1] 

机构地区：[1]郑州大学第一附属医院小儿外科,450052 [2]解放军第71620部队保障处

出　　处：《中华小儿外科杂志》2015年第11期836-839,共4页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金资助项目（编号：81172085）

摘　　要：目的探讨儿童原发性胃肠道淋巴瘤（primary gastrointestinal lymphoma，PGIL）的临床特点、病理分型，总结最佳诊断与治疗方案，并进行疗效分析。试图探究外科手段介入原发性胃肠道淋巴瘤治疗的疗效，为儿童原发性胃肠道淋巴瘤的治疗提供系统全面的诊疗方案。方法回顾性分析我院2010年6月至2014年5月诊治的20例原发性胃肠道淋巴瘤患儿的发病过程及诊疗经过，并对患儿进行随访。结果20例均成功随访，最长随访期为43个月。排除性别、年龄、临床分期、细胞分型等对预后因素的影响后，对治疗方法进行单因素变量分析。手术联合化疗组2例复发，1例死亡，3年总生存率90．9％，3年无复发生存率81．8％；单纯化疗组5例复发，3例死亡，3年总生存率66．7％，3年无复发生存率44．4％。手术联合化疗组患儿3年中位生存期是41．0个月，单纯化疗组患儿3年中位生存期是24．9个月，两组生存期经Kaplan-Meier统计分析，差异有统计学意义（P〈0．05）。采用Fisher确切概率法对两组患儿复发率进行比较，差异无统计学意义（P〉0．05）。结论儿童肠道非霍奇金淋巴瘤以B细胞淋巴瘤居多，恶性程度高。手术联合化疗相比单纯化疗能延长原发性胃肠道淋巴瘤患儿的生存时间，降低患儿疾病死亡率，但并不能降低患儿复发率，为增加结论可信度，有必要扩大实验组及对照组病例数量和延长观察期。Objective To explore the clinical features, pathological types, diagnosis, treatment and efficacy of primary gastrointestinal lymphoma （PGIL） in childrerL Methods The clinical data were reviewed for 20 children with a definite diagnosis of PGIL. And follow-ups were conducted. Results The longest follow up period was 43 months. After eliminating the effects of gender, age, clinical staging and cell typing, single factor variance analysis was performed on treatment modalities. In operation plus chemotherapy （A） group, there were recurrence （n = 2） and death （n = 1）. And the 3-year overall survival rate was 90. 9% and 3-year disease-free survival rate 81.8%. In chemotherapy alone （B） group, there were recurrence （n = 5） and death （n = 3）. And the 3-year overall survival rate was 66.7% and 3-year disease-free survival rate 44. 4%. The median survival time was 41.0 months in group A versus 24. 9 months in group B. According to the Kaplan-Meier statistical analysis, the survival time of group A was longer than that of group B（P〈0. 05）. The relapsing rates of two groups were compared by Fisher＇s exact probability method. And there was no significant difference （P〉 0.05）. Conclusions Mature B-cell lymphoma accounts for a majority of pediatric non-Hodgkin＇ s lymphoma （NHL） cases. NHL is highly aggressive. Comparing with chemotherapy alone, the overall survival time could be prolonged by surgery plus chemotherapy with a lower mortality. However, the relapse rate could not be reduced. And it is essential to expand sample size and extend observation period.

关 键 词：儿童 淋巴瘤 胃肠肿瘤 外科手术 化学疗法 辅助 

分 类 号：R735[医药卫生—肿瘤]