原发性胃肠道淋巴瘤的诊断与治疗(附30例报告)  

Diagnosis and treatment of primary gastrointestinal lymphoma:a report of 30 cases

作　　者：刘亮[1] 徐向上[1] 曹志新[1] Liu Liang;Xu Xiangshang;Cao Zhixin(Department of Gastrointestinal Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Gastrointestinal Cancer Research Institute,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胃肠外科华,中科技大学同济医学院附属同济医院胃肠肿瘤研究所,湖北武汉430030

出　　处：《腹部外科》2022年第2期99-102,107,共5页Journal of Abdominal Surgery

摘　　要：目的总结原发性胃肠道淋巴瘤的诊断和治疗体会。方法回顾性分析华中科技大学同济医学院附属同济医院胃肠外科2013年9月至2016年4月收治的30例原发性胃肠道恶性淋巴瘤病人的临床症状、诊断、治疗、病理及随访资料。结果临床症状主要为腹痛(63.3%,19/30)、腹部包块(20.0%,6/30)、消化道出血(13.3%,4/30)、肠梗阻(6.7%,2/30);18例行内镜及活检,其中5例确诊为原发性胃肠道淋巴瘤(确诊率为27.8%);腹部增强CT诊断率为20.0%(5/25);术前诊断率为33.3%(10/30)。手术治疗26例,化疗21例;总体5年存活率为50.0%(15/30),其中ⅠE期者5年存活5例,Ⅱ期存活5例,ⅡE期存活2例,Ⅳ期存活3例。治疗效果方面:单纯化疗病人的5年存活率为100.0%,手术+化疗病人的5年存活率为66.7%,单纯手术的病人5年存活率为0。结论原发性胃肠道恶性淋巴瘤术前诊断率较低,误诊率较高;手术切除是明确诊断、临床分期和治疗的重要方法,单纯化疗或手术联合化疗具有较好的治疗效果。Objective To summarize the experience of diagnosing and treating primary gastro-intestinal lymphoma(PGIL).Methods From September 2013 to April 2016,30 hospitalized PGIL patients were recruited.Clinical symptoms,diagnosis,treatment and prognosis were analyzed.Results Major manifestations included abdominal pain(63.3%,19/30),abdominal mass(20.0%,6/30),gastrointestinal bleeding(13.3%,4/30)and intestinal obstruction(6.7%,2/30).Definite diagnoses were made by endoscopy&biopsy pathology(27.8%,5/18)and contrast-enhanced abdominal CT(20.0%,5/25).The preoperative diagnostic rate was 33.3%(10/30).Another 20 cases were diagnosed postoperatively.Twenty-six patients were operated while another 21 received chemotherapy.The overall 5-year survival rate was 50.0%.The number of 5-year survivors with stagesⅠE,Ⅱ,ⅡE andⅣwas 5,5,2 and 3respectively.Regarding therapeutic efficacy,5-year survival rate of patients with chemotherapy alone was 100.0%,those with surgery plus chemotherapy 66.7%while those with surgery alone 0.Conclusion The preoperative diagnostic rate of primary gastrointestinal lymphoma is low and its misdiagnostic rate remains high.Surgical resection is vital for diagnosis,clinical staging and treatment.Chemotherapy alone or surgery plus chemotherapy offers a better therapeutic efficacy.

关 键 词：原发性胃肠道淋巴瘤 结外淋巴瘤 诊断 治疗 

分 类 号：R733[医药卫生—肿瘤]