原发性肺淋巴瘤的临床诊断和外科治疗

目的 探讨原发性肺淋巴瘤的临床特点、诊断和外科治疗的原则。方法回顾分析10例原发性肺淋巴瘤的临床资料。8例为非霍奇金淋巴瘤（B细胞型）,2例为霍奇金病（混合细胞型）。肿瘤位于左上肺2例,左下肺1例,右上肺3例,右中肺3例,右下肺1例。临床症状多为咳嗽和（或）咯血,影像学（胸部X线和CT检查）表现类似于原发性肺癌。所有患者纤维支气管镜检查未发现异常。8例术前根据影像学表现误诊为原发性肺癌,仅2例经皮肤肺穿刺活检行病理检查诊断为原发性肺淋巴瘤。所有患者均接受肺切除术和同侧肺门及纵隔淋巴结清除,术后2例霍奇金病患者分别行MOPP方案（氮芥、长春新碱、丙卡巴肼和泼尼松）和ABVD方案（阿霉素、博莱霉素、长春花碱和达卡巴嗪）化学治疗（化疗）;8例非霍奇金淋巴瘤行CHOP方案（环磷酰胺、阿霉素、长春新碱和泼尼松）化疗,其中3例行放射治疗。结果至随访时,6例非霍奇金淋巴瘤（ⅠE期3例,Ⅱ1E期2例,Ⅱ2E W期1例）手术后已经存活18～42个月,2例非霍奇金淋巴瘤（Ⅱ2E期,低度恶性B淋巴细胞型）和2例霍奇金病（ⅠE期和Ⅱ2E期各1例,混合细胞型）分别在手术后24,32,8和17个月死亡。结论原发性肺淋巴瘤缺乏特异性表现,手术前准确诊断比较困难。治疗选择手术治疗和手术后放射治疗、正规全身化疗的综合治疗。

Clinical diagnosis and surgical treatment of primary pulmonary lymphoma

OBJECTIVE: To study the clinical characteristics, the principles of diagnosis and surgical treatment for primary pulmonary lymphoma. METHOD: Ten patients with primary pulmonary lymphoma were treated surgically and their clinical characteristics, the experiences of clinical diagnosis and surgical treatment were analyzed. The tumors located in left upper lobe in 2, left lower lobe in 1, right upper lobe in 3, right middle lobe in 3 and right lower lobe in 1. The main symptoms were cough and (or) hemoptysis. Imageological representations (X-ray and CT scanning of thorax) were similar to primary pulmonary carcinoma. Broncho-fibroscopic examination was performed on all cases with negative findings. Eight cases were mistakenly diagnosed as primary pulmonary carcinoma by imageological representations. Only 2 cases were diagnosed as primary pulmonary lymphoma by percutaneous needle biopsy and pathologic examination. All cases received pneumonectomy, ipsilateral hilar and mediastinal lymphadenectomy. All cases with non-Hodgkin's lymphoma received regular chemotherapy (MOPP and ABVD scheme for 1 case with Hodgkin's disease respectively, CHOP for 8 cases with non-Hodgkin's lymphoma), and 3 cases received radiotherapy postoperatively. RESULTS: Eight cases were non-Hodgkin's lymphoma (B-type) and 2 cases were Hodgkin's disease (mixed type) confirmed by pathological examination. Six cases with non-Hodgkin's lymphoma (3 cases for stage IE, 2 cases for stage II 1E, and 1 case for stage II 2E W) had been surviving for 18-42 months until the follow-up. Two cases with non-Hodgkin's lymphoma (stage II 2E, B-cell, low-grade) and 2 cases with Hodgkin's disease (stage IE and II 2E, mixed type) died in 24, 32, 8 and 17 months postoperatively respectively. CONCLUSIONS: Primary pulmonary lymphoma is a rare type of malignant lung neoplasm without special clinical features. The preoperative diagnosis is difficult. Treatment modalities include surgical treatment, radiotherapy and regular chemotherapy postoperatively.