24例原发性结直肠非霍奇金淋巴瘤临床表现及内镜和病理特点

目的探讨原发性结直肠非霍奇金淋巴瘤的临床表现及内镜和病理特点。方法回顾性分析24例原发性结直肠非霍奇金淋巴瘤患者的临床资料。结果全组临床表现以腹痛、腹块、体重下降、发热、便血和大便习惯改变为主。多部位病变[涉及2个（包括2个）以上]6例（25．0％），其中3例由乙状结肠至升结肠呈跳跃样连续分布，1例病变为全结直肠跳跃样连续分布，1例涉及升结肠和直肠，1例涉及直肠和乙状结肠；单部位病变18例，以回盲部最多（44．4％，8例）。内镜下39．1％表现为溃疡型，43．5％为隆起型，17．4％为浸润型。11例（45．8％）病理分型为弥漫性大B细胞淋巴瘤，8例（33．3％）为肠道外周T细胞淋巴瘤，3例（12．5％）为黏膜相关淋巴组织边缘带B细胞淋巴瘤，2例（8．3％）未作分型。21例手术，其中根治性切除15例，局部切除1例，姑息切除4例，剖腹探查活检1例；16例（66．7％）术后加用CHOP（环磷酰胺、表阿霉素、长春新碱、泼尼松）或COP（环磷酰胺、长春新碱、泼尼松）方案化疗，放弃治疗3例。随访21例患者，5年生存率37．7％。结论原发性结直肠非霍奇金淋巴瘤临床表现无特异性；内镜以溃疡型和隆起型多见；病理分型以弥漫性大B细胞淋巴瘤和肠道外周T细胞淋巴瘤为主。手术加化疗的综合治疗是提高生存率的有效手段。

Clinical, endoscopic and pathological features of primary colorectal non-hodgkin lymphoma: 24 cases report

Objective To investigate the clinical,endoscopic and pathological features in primary colorectal non-Hodgkin lympboma.Methods Twenty-four cases of primary eolorectal non-Hodgkin lymphoma were studied retrospectively.Results The main clinical symptoms were abdominal pain, abdominal mass,loss of weight,fever,bloody stools and altered bowel habits.There were 6 cases(25.0% ) involving two or more lesion sites,including three cases showing continuous skip-distribution from sigmoid colon to ascending colon,one case showing the homologous manifestation from rectum to cecum,one case involving ascending colon and rectum,and the last one involving sigmoid colon and rectum.There were 18 cases involving single lesion site and the caecum was the most frequently affected site (44.4%,8 cases). The major endoscopic phenotypes were ulcer (39.1%),bossing(43.5%) and infiltrating(17.4%).The major pathology types were diffuse large B-cell lymphoma(11/24,45.8%),intestinal T-cell lymphoma (8/24,33.3%),and mucosa-associated lymphoid tissue lymphoma(MALT)(3/24,12.5%).2 of 24 cases (8.3%) were not decided.Twenty-one patients were treated surgically,containing fifteen radical excisions, one local excision,four palliative excisions and one exploratory laparotomy.Sixteen postoperative patients accepted CHOP(cyclophosphamide,doxorubicin,vincristine,prednisone) or COP (cyclophosphamide, vincristine,prednisone) chemotherapy,and three patients abandoned treatment.Twenty-one patients were followed up and the 5-year survival rate was 37.7%.Conclusion The clinical features of primary colorectal non-hodgkin's lymphoma have no specificity.Ulcer and bossing are the two major morphologic manifestations of endoscopic.Diffuse large B-cell lymphoma and intestinal T-cell lymphoma are the main pathological types.Comprehensive treatment of surgery and chemotherapy are effective methods for primary colorectal non-hodgkin lymphoma.