原发性肝癌合并非霍奇金淋巴瘤两例分析并文献复习  

Primary liver cancer complicated with non-Hodgkin's lymphoma:two cases analysis and literature review

作　　者：熊志勇[1] 胡昆鹏[2] 姚志成[2] 许瑞云[1] 邓美海[1] 

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630 [2]中山大学附属第三医院岭南医院普通外科,广州510530

出　　处：《中华肝脏外科手术学电子杂志》2016年第3期177-180,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省自然科学基金(S2013010016015);广州市科技计划项目(2013J4100061)

摘　　要：目的探讨原发性肝癌（肝癌）合并非霍奇金淋巴瘤的临床特点。方法回顾性分析2006年1月至2015年7月在中山大学附属第三医院收治的2例及文献检索的18例肝癌合并非霍奇金淋巴瘤患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。观察患者的发病情况、诊疗过程、治疗方案及疗效预后。检索Pub Med数据库1994年1月至2015年12月的相关文献,进行文献复习。结果患者男17例,女3例;发病年龄为35~80岁,中位年龄64岁。肝细胞癌19例,混合型1例。90%（18/20）的患者有肝炎病毒感染,其中HBV感染8例,HCV感染10例。所有患者均为B细胞性非霍奇金淋巴瘤,以弥漫性大B细胞淋巴瘤为主,占60%（12/20）,其余依次为滤泡性淋巴瘤5例,黏膜相关性淋巴样组织（MALT）淋巴瘤1例,边缘区淋巴瘤1例,未确定类型淋巴瘤1例。本组患者的非霍奇金淋巴瘤主要病变部位依次为肝脏9例,脾脏3例,淋巴结3例,胃3例,椎体1例,其他非组织脏器1例。治疗方案为手术切除＋化疗9例,射频消融或TACE＋化疗6例,肝移植1例,姑息治疗4例。患者术后中位生存时间为48（5~105）个月,而姑息治疗患者的生存时间均小于1个月。结论肝癌合并非霍奇金淋巴瘤患者以男性为主,非霍奇金淋巴瘤的病理类型均为B细胞性,其发病与HBV感染密切相关,无特异性临床表现,确诊依靠病理学检查,治疗方式首选根治性手术切除。Objective To investigate the clinical characteristics of primary liver cancer（PLC） complicated with non-Hodgkin＇s lymphoma.Methods Clinical data of 2 patients with PLC complicated with non-Hodgkin＇s lymphoma admitted and treated in the Third Affiliated Hospital of Sun Yat-sen University between January 2006 and July 2015 as well as 18 patients reported by the literature were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.The incidence,diagnosis and treatment process,therapeutic regimen,curative effect and prognosis were observed.Relevant literature in Pub Med database from January 1994 to December 2015 was searched for literature review.Results Among the patients,17 were males and 3 were females with the onset age ranging from 35 to 80 years old and the median of 64 years old.Nineteen cases were with hepatocellular carcinoma and 1 with mixed type liver cancer.Hepatitis virus infection was found in 90%（18/20） of the patients with 8 cases of hepatitis B virus（HBV） infection and 10 of hepatitis C virus（HCV） infection.All patients were complicated with B-cell non-Hodgkin＇s lymphoma.The main type was diffuse large B-cell lymphoma,accounting for 60%（12/20）.And the other types were follicular lymphoma（n=5）,mucosa-associated lymphoid tissue（MALT） lymphoma（n=1）,marginal zone lymphoma（n=1） and unspecified lymphoma（n=1）.The main lesions of non-Hodgkin＇s lymphoma respectively located in the liver（n=9）,spleen（n=3）,lymph node（n=3）,stomach（n=3）,vertebral body（n=1）,other non-tissue and visceral organ（n=1）.The therapeutic regimens were operation ＋ chemotherapy（n=9）,radiofrequency ablation or transcatheter arterial chemoembolization（TACE） ＋ chemotherapy（n=6）,liver transplantation（n=1） and palliative treatment（n=4）.The median postoperative survival time of the patients was 48（5-105） months,while the survival time of the patients receiving palliative t

关 键 词：癌 肝细胞 淋巴瘤 非霍奇金 肝炎病毒 乙型 病理学 外科手术 

分 类 号：R735.7[医药卫生—肿瘤] R733.1[医药卫生—临床医学]