原发性小肠淋巴瘤18例临床分析  

Clinical analysis of 18 cases of primary small intestinal lymphoma

作　　者：吴蓉 张彦秋 陈彬 文珍 彭雪梅 蔡龙娇 冷爱民[1] WU Rong;ZHANG Yanqiu;CHEN Bin;WEN Zhen;PENG Xuemei;CAI Longjiao;LENG Aimin(Department of Gastroenterology,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院消化内科,湖南长沙410008

出　　处：《胃肠病学和肝病学杂志》2021年第8期908-914,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：省技术创新引导计划—临床医疗技术创新引导项目(2018SK52603)。

摘　　要：目的总结分析原发性小肠淋巴瘤(primary small intestinal lymphoma,PSIL)的临床特点和诊治经验,旨在提高对该病的早期认识。方法回顾性分析中南大学湘雅医院2012年8月1日至2019年7月31日收治的18例PSIL患者的临床资料。结果18例PSIL患者中,男女各9例,发病年龄(53.8±14.4)岁;临床表现主要为腹痛(77.78%)、体质量下降(33.33%)、腹胀(22.22%)、呕吐(16.67%);大部分患者体格检查无阳性体征(61.11%);血液学检查结果中,18例PSIL患者中白细胞计数升高3例(16.67%),以中性粒细胞升高为主;贫血9例(50.00%);血清白蛋白降低14例(77.78%),血清球蛋白降低2例(11.11%),血清总胆红素升高1例(5.56%),未发现转氨酶异常患者;7例患者完善血沉,其中4例升高,5例患者完善C反应蛋白,其中3例升高;5例患者完善降钙素原,均有不同程度升高;14例患者完善肿瘤标志物12项,其中CA125升高者4例,铁蛋白升高者6例;8例患者完善腹部彩超检查,3例(37.50%)发现肠系膜及其周围多发淋巴结肿大;12例患者行CT检查,CT下病变部位主要表现依次为:肠管增厚8例(66.67%),肠系膜淋巴结肿大6例(50.00%);肠管占位性病变5例(41.67%);多发结节2例(16.67%);小肠穿孔1例(8.33%);8例患者行PET-CT检查,PET-CT下病变部位主要表现依次为:肠壁增厚5例(62.50%),肠管周围多发淋巴结肿大4例(50.00%),肿块1例(12.50%),串珠样改变1例(12.50%);18例患者中肿瘤累及部位以回肠为主,有10例(55.56%);病理类型以弥漫性大B细胞淋巴瘤多见,有11例(61.11%);18例患者中,10例(55.56%)接受外科手术,术后6例行辅助化疗,6例(33.33%)仅化疗;18例(100%)患者均获得随访,完全缓解者6例(33.33%),部分缓解者6例(33.33%),病情稳定者1例(5.56%),病情进展者5例(27.78%)。结论PSIL常无特异性临床症状及体征,病变部位以回肠多见,临床上PET-CT联合内镜检查是值得推崇的诊断手段,多数患者经手术联合化疗可获得较好预后。Objective To summarize and analyze the clinical characteristics and treatment experience of primary small intestinal lymphoma(PSIL)for improving the early recognition of this disease.Methods The clinical data of 18 patients with PSIL who were admitted to Xiangya Hospital of Central South University from Aug.1st,2012 to Jul.31st,2019 were retrospectively analyzed.Results Among the 18 patients with PSIL,9 cases were males and 9 cases were females,the age of onset was(53.8±14.4)years old.The major symptoms of PSIL included abdominal pain(77.78%),weight loss(33.33%),abdominal distension(22.22%)and vomiting(16.67%).Most of the 18 patients had no positive signs(61.11%).In the hematological examination,3 patients(16.67%)had an elevated white blood cell count comprised mainly of neutrophils.The anemia was observed in 9 cases(50.00%).Fourteen patients(77.78%)showed decreased albumin level and 2 cases(11.11%)decreased globulin level and elevated total bilirubin was observed in 1 case(5.56%),no abnormal transaminase was found.Four patients showed increased erythrocyte sedimentation rate(ESR)level in 7 cases,and 3 patients had an increased C-reactive protein(CRP)level in 5 cases.Five patients underwent procalcitonin(PCT)tests,all of which increased to varying degrees.In 14 patients who received the tumor markers test,an elevated CA125 was observed in 4 cases and ferritin elevated in 6 cases.Enlarged mesenteric lymph nodes were detected by abdominal ultrasound in 3 of 8 PSIL cases.Twelve patients underwent abdominal CT examination,which showed intestinal wall thickening(66.67%),mesenteric lymph node enlargement(50.00%),intestinal space occupying lesions(41.67%),multiple nodules(16.67%),perforation(8.33%).Eight cases had a PET-CT examination,and the lesions showed in-testinal wall thickening(62.50%),multiple lymph node enlargement near the intestine(50.00%).PSIL mainly involved ileum(55.56%),of all the 18 patients,11 cases(61.11%)were with B-cell subtype PSIL.Ten of the 18 patients(55.56%)were treated with surgical procedure,

关 键 词：原发性淋巴瘤 小肠 临床特点 

分 类 号：R735.3[医药卫生—肿瘤]