摘要
目的:分析原发性胃肠道淋巴瘤(PGIL)的诊断与治疗现状,以期提高其诊治水平。方法:对81例PGIL的临床表现、内镜特征、病理特点、HP感染、治疗方案以及预后进行回顾性分析。结果:胃淋巴瘤患者年龄(52.84±15.33)岁,肠淋巴瘤患者年龄(42.09±15.28)岁。常见症状:腹痛76.5%,消化道出血55.6%,贫血54.3%,腹部包块25.9%,低蛋白血症40.7%,肠梗阻11.1%,腹胀、呕吐、纳差、反酸等非特异性消化道症状32.1%,体质量明显下降33.3%,发热8.6%,腹泻7.4%,消化道穿孔1.2%,便秘1.2%,吞咽困难1.2%。内镜下表现为肿块型67.7%,溃疡型27.7%,弥漫型4.6%。临床诊断率及内镜下活检病理确诊率分别为30.9%和73.8%。MALT淋巴瘤占61.7%。HP检测率39.5%,阳性率37.5%。69例接受手术治疗,其中3例术前化疗,34例术后化疗。12例非手术治疗,其中6例单纯化疗及HP根除治疗,另6例放弃治疗。单纯手术、手术加化疗、单纯化疗及HP根除治疗3种方法的存活率在Ⅰ～Ⅱ期患者无显著性差异(P>0.05)。Ⅲ～Ⅳ期患者中单纯手术组存活率低于其他两组(P<0.05)。1年生存率为96.39%,3年生存率为70.96%,5年生存率为55.87%。结论:PGIL的临床及镜下表现缺乏特异性,临床误诊率高,建议多部位活检或重复多次活检,并应用免疫组织化学方法提高病理诊断率。治疗首选化疗及HP根除治疗。
Objective To analyze the status quo of the diagnosis and treatments of primary gastrointestinal lymphoma （PGIL） in order to improve it. Methods Eighty-one patients with PGIL were analyzed retrospectively including clinical manifestations, endoscopic features, pathological features, HP infection, treatment, and prognosis. Results The age of patients with gastric lymphoma was （52.84±15.33 ） years. The age of patients with intestinal lymphoma was （42.09 ± 15.28 ） years. Common symptoms included abdominal pain （76.5%）, gastrointestinal bleeding （55. 6% ）, anemia （54. 3% ）, abdominal mass （25.9%）, hypoproteinemia （40.7%）, bowel obstruction （ 11.1% ）, abdominal distension, vomiting, and other non-specific gastrointestinal symptoms （32.1%）, weight loss （33.3%）; fever （8.6%）, diarrhea （7.4%）, digestive tract perforation （ 1.2% ）, constipation （ 1.2% ）, and dysphagia （1. 2% ）. Endoscopic appearances were as follows： tumor type （67. 7% ）, ulcer type （27.7%）, and diffuse type （4.6%）. Clinical diagnosis rate and endoscopic biopsy confirmation rate were 30.9% and 73.8%. MALT lymphoma accounted for 61.7% of the patients. HP detection rate was 39.5% and positive rate was 37.5%. A total of 69 patients received surgeries： 3 had preoperative chemotherapy, and 34 had postoperative chemotherapy. Twelve patients had non-surgical treatment, 6 patients of whom had simple chemotherapy and HP eradication therapy, and the other 6 gave up during the treat- ment. There was no significant difference in the survival rate of Stage Ⅰ-Ⅱ patients in the surgery alone group, surgery plus chemotherapy group, and chemotherapy and HP eradication therapy group （P 〉 0.05）. The survival rate of Stage Ⅲ-Ⅳ patients in the surgery alone group was lower than that in the other 2 groups （P 〈0.05）. The 5-year, 3-year, and 1-year survival rate was 55.87% , 70.96% , and 96.39%, respectively. Conclusion There are no specific clinical and endoscopic features in PGIL, so the misdiagnosis rate is high. Multi-site biopsy or repeated biopsies and immunohistochemical methods can be used to raise the pathological diagnosis rate. Chemotherapy and HP eradication are recommended.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2009年第7期582-588,共7页
Journal of Central South University ：Medical Science
关键词
原发性胃肠道淋巴瘤
临床特征
病理分型
化疗
手术
预后
primary gastrointestinal lymphoma
clinical character
pathological types
chemotherapy
surgery
prognosis
