原发性小肠淋巴瘤的诊断和外科治疗

目的探讨原发性小肠淋巴瘤（primary small intestine lymphoma,PSIL）的临床表现、CT特点,提出临床策略。方法回顾性分析2003年1月至2007年7月收治的15例PSIL的患者临床资料。结果15例患者中男9例,女6例,平均51.6岁。PSIL常见的临床表现为：腹痛、腹部肿物、肠梗阻、消化道出血及消瘦;血CEA、CA199均正常。术前15例均行CT检查,CT初诊检出肿瘤15例,定性诊断准确12例;15例中,11例行消化道钡餐检查,4例检出病变,仅1例提示淋巴瘤可能。15例患者均行手术治疗,无围手术期死亡,术后病理结果为PSIL,术后1年生存率为85.7%。结论PSIL无特异性临床症状,消化道钡餐诊断率低,CT扫描具有一定的特征,结合临床具有较高的诊断价值。早期诊断对改善PSIL的预后十分重要,积极手术切除和辅助化疗可以获得良好效果。

Diagnosis and surgical treatment of primary small intestine lyphoma

Objective To approach the diagnosis and treatment of primary lymphoma of the small intestine. Methods The clinical data of 15 patients with primary lymphoma of the small intestine from January 2003 to July 2007 were reviewed. Results Of the 15 cases ,9 cases were male and 6 cases were female, the av- erage age was 51.6 years. The commonest clinical manifestation were as follow： abdominal pain, abdominal lump, bowel obstruction, alimentary tract hemorrhage and athrepsy. CEA and CA199 values of blood serum were normal. All of these cases were under went CT scanning before operation. In 12 of 15 cases were final diagno- sised by CT scanning. 11 cases were subjected to Ba-meal examinations. Positive results were found in 4 cases, and only q case was considered to be PSIL. All of them received surgical operation. The postoperative pathology of all the patients were primary small intestine lymphoma. The 1year postoperative survival rate was 85.7%. Conclusion PSIL had no specificity clinical manifestation. Barium study had hypo-diagnosis ratio, CT scan had specific diagnostic characteristics for PSIL. In combination with CT scan and clinical manifestation examinations are mutually beneficial in the diagnostic process. Most of the patients with primary lymphoma of the small intestine were in advanced stages when operated or diagnosed, so early diagnosis and comprehensive therapy were the key to ameliorate the patients＇ prognosis.