以急性上消化道出血为首发表现的25例胃原发淋巴瘤病例分析及治疗经验总结

  目的  总结以急性上消化道出血为首发表现的胃原发淋巴瘤临床特点及治疗经验，为临床治疗提供依据。  方法  回顾性收集2010年1月–2021年3月因急性上消化道出血收入四川大学华西医院消化内科的胃原发淋巴瘤患者的信息。记录并分析患者胃淋巴瘤内镜下形态、肿瘤分期、病理类型、出血严重程度、再出血风险、治疗及住院预后情况。  结果  总共纳入25例患者，平均年龄57.2岁，临床表现均出现黑便（100%），9例（36%）存在呕血，6例（24%）合并腹痛。以出血为首发表现的胃淋巴瘤患者内镜下20例（80%）表现为肿瘤形成型（八尾分型），累及胃体中部及下部多见（分别为44%、32%）。经常规药物保守治疗，在院期间4例发生再出血，其中1例需要内镜下止血，2例需要外科切除止血，1例放弃治疗。仅1例患者死于感染，但无出血直接导致的死亡。  结论  胃原发淋巴瘤以急性上消化道出血为唯一临床表现者罕见，内镜下累及范围较广。常规用于治疗急性上消化道出血的药物保守治疗可以控制其出血症状，但容易发生再出血，保守治疗无效可尝试内镜或者外科治疗。

Analysis and Treatment Experience of 25 Cases of Primary Gastric Lymphoma with Acute Upper Gastrointestinal Bleeding as the Primary Manifestation

  Objective  To summarize the clinical characteristics and treatment experience of gastric primary lymphoma with acute upper gastrointestinal bleeding as the primary manifestation, and to provide support for clinical treatment.  Methods  Information on gastric primary lymphoma patients admitted to the Department of Gastroenterology, West China Hospital of Sichuan University between January 2010 and March 2021 for acute upper gastrointestinal bleeding was retrospectively collected. Data on endoscopic morphology, tumor staging, pathology typing, severity of bleeding, risks of rebleeding, treatment and inhospital prognosis were documented and analyzed.   Results  A total of 25 patients with a mean age of 57.2 years were included in the study, all of whom presented clinically with melena (100%), 9 (36%) had hematemesis, and 6 (24%) was accompanied with abdominal pain. Twenty, or 80%, of the gastric lymphoma patients with bleeding as the primary manifestation showed endoscopically a tumor-forming phenotype (Yao Classification), mostly involving the middle and lower parts of the gastric body (44% and 32%, respectively). After conservative treatment with medication, rebleeding occurred in 4 patients during hospitalization. One of them required endoscopic hemostasis, two required surgical resection to stop the bleeding, and one decided not to undergo any further treatment. Only one patient died from infection and no death resulted directly from severe bleeding.   Conclusion  Gastric primary lymphoma presenting acute upper gastrointestinal bleeding as the sole clinical manifestation rarely occurs, but when the condition does occur, it shows a wide range of endoscopic involvement. It has a higher risk of rebleeding, and endoscopic or surgical treatment may be attempted when conservative medication treatment for acute upper gastrointestinal bleeding fails.