86例肺黏膜相关淋巴组织淋巴瘤的外科诊治  

Surgical management of pulmonary mucosa-associated lymphoid tissue-derived lymphoma:retrospective study of 86 cases

作　　者：徐小雄[1] 万紫微 刘鸿程[1] 汪浩[1] 朱余明[1] 姜格宁[1] Xu Xiaoxiong;Wan Ziwei;Liu Hongcheng;Wang Hao;Zhu Yuming;Jiang Gening(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《中华胸心血管外科杂志》2022年第10期599-603,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结肺黏膜相关淋巴组织(MALT)淋巴瘤的诊治经验,探讨外科手术在诊治中的作用。方法回顾性分析2000年1月至2018年12月期间在同济大学附属上海市肺科医院胸外科诊治的86例肺MALT淋巴瘤患者临床资料及随访情况。其中男44例,女42例;年龄27~78(56.7±10.6)岁。48例(55.8%)因体检异常就诊发现;38例(44.2%)因出现症状就诊,主要表现为咳嗽、咳痰。病灶位于左肺17例,右肺49例,双肺19例;局限单肺叶56例,多肺叶29例。胸部CT检查主要表现为常伴有支气管充气征的斑片实变影(39例)和实性结节或肿块(37例)。术前确诊8例(9.3%)。58例完全切除病灶,其中10例辅助化疗;17例仅切除主要病灶,其中8例辅助化疗;余11例因诊断不明行肺活检,其中6例行化疗,1例行放化疗,4例未治疗。结果所有患者均顺利完成手术,无围手术期死亡。术中失血量(202±118)ml,术后住院(6.7±4.7)天。术后并发症主要包括围手术期输血5例、心律失常1例、术后肺复张差行气管镜吸痰2例和乳糜胸1例。术后失访3例,余83例术后随访24~219个月,中位随访64个月。Kaplan-Meier生存分析结果显示:83例患者5年和10年的总生存(OS)率分别为95.0%和76.8%,5年和10年的无进展生存(PFS)率分别是75.7%和35.1%。完全切除病灶者的PFS率优于非完全切除病灶者(P<0.001),但两者OS率差异无统计学意义(P=0.395)。55例完全切除病灶患者,术后化疗和未化疗的OS率、PFS率差异均无统计学意义(P>0.05)。结论肺MALT淋巴瘤是一种预后较好的惰性淋巴瘤。非手术方式确诊率很低。外科手术能显著提高确诊率,又能根治切除早期局限病灶达到较好疗效,对本病的诊治具有重要作用。Objective To summarize our experience in diagnosis and treatment of patients with pulmonary mucosa-associated lymphoid tissue-derived(MALT)lymphoma and to explore the role of surgery.Methods We retrospectively analyzed the clinical and follow-up data of 86 patients with pulmonary MALT lymphoma in Shanghai Pulmonary Hospital from January 2000 to December 2018.86 cases were identified with 44 males and 42 females.The mean age was(56.7±10.6)years old.38(44.2%)cases had symptoms mainly presenting as cough and sputum at diagnosis.The chest CT scan of the patients showed pulmonary consolidation in 39 cases,nodule/mass shadow in 37 cases,usually with air bronchogram.Only 8(9.3%)cases could be diagnosed by non-surgical approach.58 cases received complete resection,10 of which followed chemotherapy.8 of 17 cases who received incomplete resection accepted chemotherapy.The rest 11 cases who experienced surgical biopsy because of uncertain diagnosis were treated by chemotherapy or radio-chemotherapy or just watch-to-wait.Results The median follow-up of 83 cases was 64 months,ranged from 24 to 219 months.The estimated 5-year and 10-year OS rates were 95.0%and 76.8%,while 5-year and 10-year PFS were 75.7%and 35.1%respectively.Patients who received complete resectionhad better PFS(P<0.001)but similar OS(P=0.395),compared with those received incomplete resection.There were no significant difference in OS and PFS between patients who received complete resection accepted chemotherapy or not(P>0.05).Conclusion Pulmonary MALT lymphoma has an indolent nature with an excellent long-term survival.Diagnosis is difficult to be made by non-surgical approach.Surgery plays an important role of treatment of pulmonary MALT lymphoma,due to significant improvement of diagnosis rate and radical treatment of localized disease by complete resection.

关 键 词：肺肿瘤 黏膜相关淋巴组织淋巴瘤 诊断 治疗 外科手术 

分 类 号：R734.2[医药卫生—肿瘤]