原发性胃恶性淋巴瘤的临床诊治分析

目的 探讨原发性胃恶性淋巴瘤（PGML）的诊断、治疗与预后.方法 回顾分析2000年～2008年收治的29例经术后病理确诊为原发性胃恶性淋巴瘤的临床资料.结果 29例患者中仅6例术前经胃镜活检确诊,所有患者均行手术治疗,26 例患者术后辅以化疗,手术切除率为89.7%.免疫组化证实B细胞型淋巴瘤27例,T细胞型淋巴瘤2例.25例获得随访,5年生存率为56%,其中Ⅰ期＋Ⅱ期5年生存率为61.9%（13/21）;Ⅲ＋Ⅳ期5年生存率为25 %（1/4）.结论 PGML临床表现无特异性,容易漏诊.胃镜活检是术前诊断该病的主要方法,手术切除联合应用化疗是治疗PGML的重要手段.免疫组化及临床分期对PGML的分类以及判断预后有重要意义.

Clinical Analysis of Primary Gastric Malignant Lymphoma

Objective To explore the diagnosis,treatment and prognosis of primary gastric malignant lymphoma （ PGML）.Methods 29 cases of PGML were retrospectively analyzed in our hospital from 2000 to 2008.Results Among the 29 cases,only 6 were definitely diagnosed by gastroscopy before operation.All patients underwent operative treatment and most of the patients received chemotherapy,the resectable rate of PGML was 89.7%.27 cases exhibited B-cell phenotype and 2 patients exhibited T-cell phenotype by immunohistochemistry examination. Follow-up was complete in 25 patients,the 5-year survival rate was 56%,the 5-year survival rates of stages of I and Ⅱ patients were 61.9%,and stages of Ⅲ and lg were 25%.Conclusions The clinical manifestations of PGML have no specificity, and PGML is very likely to be misdiagnosed or neglected.Gastroscope biopsy is the main approach of diagnosis before operation,surgical resection and adjuvant chemotherapy play important role in treatment of PGML.Immunohistochemistry examination and clinical term have significance in judgement of prognosis and classification.