原发性胃肠道恶性淋巴瘤的诊治

目的:探讨原发性胃肠道恶性淋巴瘤(PGIML)的诊治方法。方法:回顾性分析1995年1月—2010年12月收治的34例原发性胃肠道恶性淋巴瘤患者临床资料。结果:全组男23例,女11例,年龄22～74(平均51.8)岁。均经病理证实为恶性淋巴瘤,原发病灶位于胃24例,肠道10例。24例胃恶性淋巴瘤患者的首发症状为上腹部隐痛不适,8例合并呕血黑便,3例伴有发热;10例肠道淋巴瘤均以腹痛、腹部包块为首发症状,4例伴有黑便,2例有肠梗阻表现,肠穿孔1例。本组24例胃恶性淋巴瘤中,仅5例经术前胃镜病理活检证实;10例肠道恶性淋巴瘤中,仅1例经结肠镜活检确诊,术前确诊率仅17.64%(6/34)。误诊时间2～8(平均4.5)个月。患者均接受手术治疗,其中行根治性肿瘤切除术32例(根治性全胃切除术8例,根治性远端胃大部切除术14例,小肠部分切除术3例,右半结肠切除术6例,根治性直肠切除术1例),姑息性远端胃大部切除术2例。术后31例患者进行了化疗。34例患者免疫组化分型属B淋巴细胞型27例,T淋巴细胞型4例,未分类型3例。全组均获随访,随访时间5～62个月,1,3,5年生存率分别为82.35%,64.71,47.05%。结论:原发性胃肠道恶性淋巴瘤术前确诊率低,胃肠镜及病理活检是术前确诊的主要方法,以手术化疗联合的综合治疗效果良好。

Diagnosis and treatment of primary gastrointestinal malignant lymphoma

Objective: To explore the diagnosis and treatment of primary gastrointestinal malignant lymphoma(PGIML). Methods: The clinical data of 34 PGIML patients admitted to our department from January 1995 to December 2010 were retrospectively analyzed. Results: The patients of whole group comprised 23 male and 11 female cases,whose ages ranged from 22 to 74 years(average of 51.8).All patients were pathologically confirmed to have PGIML,of whom,in 24 cases the primary tumor was located in the stomach and 10 in the intestinal tract.The initial onset symptoms of the 24 patients with gastric lymphoma were epigastric pain or discomfort,and in 8 cases was accompanied with melena and 3 cases with fever.While the initial symptoms in the 10 patients with intestinal lymphoma were abdominal pain and mass,and 4 cases were complicated with melena,2 cases with symptoms of bowel obstruction and 1 case had signs of intestinal perforation.PGIML was proved by gastroscopic biopsy in only 5 of the 24 patients with gastric lymphoma,and diagnosed by colonoscopic biopsy in only one of 10 patients with intestinal lymphoma.The preoperative diagnosis rate was 17.64%(6/34).The patients were misdiagnosed for 2 to 8 months(average of 4.5 mionths).All patients underwent surgical treatment,of whom,32 cases underwent radical tumor resection(8 cases of radical gastrectomy,14 cases of radical distal gastrectomy,3 cases of partial resection of small intestine,6 cases of right radical hemicolectomy and 1 case of radical resection of rectal tumor) and 2 cases underwent palliative subtotal gastrectomy.Thirty-one patients received chemotherapy after surgery.The immunohistochemical classifications of the 34 patients were B cell lymphoma(27 cases),T cell lymphoma(4 cases),and "non-T,non-B" lymphoma(3 cases).All patients were followed up for 5 to 62 months,and the 1-,3-and 5-year survival rates were 82.35%,64.71% and 47.05%,respectively. Conclusion: The preoperative diagnosis rate of PGIML is relatively low,and gastrointestinal endoscopy and biopsy are the main approaches for preoperative diagnosis.Comprehensive treatment including surgery and chemotherapy can confer a good therapeutic effect.