胃MALT淋巴瘤的临床病理诊断及治疗探讨

目的分析胃MALT型淋巴瘤的临床病理特点,以提高该病的诊断率。方法统计我院2006年-2010年的18例胃MALT型淋巴瘤病例,对其进行回顾性分析,总结其初始症状、内镜下特点、病理特点,探讨更有效的治疗方法。结果患者发病年龄平均60岁,男女比例1.25：1;本组18例中16例伴幽门螺杆菌感染,阳性率为88.9%;内镜下8例表现为胃窦部黏膜霜斑样糜烂,6例表现为胃窦巨大溃疡（疑似BorrmannⅢ）,3例见胃窦、胃体多灶结节性隆起,1例为胃壁弥漫浸润（疑似BorrmannⅣ）,全部病例均经胃黏膜活检病理确诊。16例HP阳性患者经根除HP治疗后12例（75%）病灶消失,随访2年未复发;直接手术者2例行术后化疗,随访5年未复发。结论胃MALT型淋巴瘤起病隐匿,症状体征缺乏特异性,容易漏诊、误诊;临床上惰性经过,预后良好;根除HP治疗是有效可行的治疗方法,治愈率高。

Investigate of Clinicopathologic Diagnosis and Treatment in MALT lymphoma of Stomach

【Objective】 To analysis the clinicopathologic characteristic of MALT lymphoma in stomach.It would improve the diagnosis rate of the disease.【Methods】 18 cases of MALT lymphoma in stomach were run by retrospective analysis between 2006 y and 2010 y.To investigate the more effective treatment methods,the cases were summarized with incipient symptoms,features of endoscope and pathology.【Results】 The average age of patients is sixty.Male female ratio is 1.25.Sixteen patients were infected by Hp.So the positive ratio is 88.9%.Mucous membrane of sinus ventriculi with the endoscope showed frost macula-like anabrosis in 8 patients.The mucous membrane showed enormous ulcer in 6 patients（Borrmann Ⅲ could not be excluded.）.The mucous membrane of sinus ventriculi and corpus gastricum showed nodosity intumesce of many parts in 3 patients.And widespread gastric wall were infiltrated in one patient（Borrmann Ⅳ could not be excluded.）.Moreover,all biopsies were diagnosed by pathology finally.Diseased region of 12 cases（75%） disappeared after Hp eradication treatment in 16 positive patients.And the disease recurrence did not occur in 2 years.The recurrence didn＇t occur in operation patients including 2 patients of post-operation chems in 5 years as well.【Conclusion】 MALT lymphoma in stomach occurs unconsciously and its symptoms and signs lack specificities.Missed diagnosis and misdiagnosis are happened easily.But its prognosis is well.So the Hp eradication treatment is effective and feasible.Its recovery rate is high.