33例小肠非霍奇金淋巴瘤治疗分析

Treatment of primary non-Hodgkin's lymphoma of the small intestine: an analysis of 33 cases

目的 探讨小肠非霍奇金淋巴瘤的临床特点、诊断、治疗和预后。方法 回顾性分析33例小肠非霍奇金淋巴瘤,其中滤泡型裂细胞性2例,弥漫型裂细胞性7例,弥漫型裂-无裂细胞性5例,弥漫型无裂细胞性6例,免疫母细胞性1例,黏膜相关淋巴组织淋巴瘤2例,弥漫性大B细胞淋巴瘤9例,另有1例为T细胞淋巴瘤。AnnAnbor分期ⅠE期12例,ⅡE期15例,ⅣE期6例。手术治疗33例,2 9例行根治术,另4例行姑息性切除术。2 6例行术后放疗,移动条照射12例,全腹盆腔大野照射14例;中位总剂量2 5 4 3.5cGy。术后化疗33例,其中CHOP方案17例,COMP方案6例,COP方案3例,MINE方案2例,COPP方案3例,BACOP方案2例。结果 5年总生存率和无病生存率分别为4 8%和39% ,中位值分别为4 7、2 3个月。各期的生存率分别为ⅠE期4 2 % ,ⅡE期6 7% ,ⅣE期17%。结论 小肠淋巴瘤多为ⅠE、ⅡE期,病理以中、高度恶性为主,治疗多采用以手术为主的综合治疗,术后放疗及化疗可提高生存率。

Objective To analyze the clinical feature, diagnosis, treatment a nd prognostic factors of primary lymphoma of the small bowel. Methods From Apr il 1989 to May 2002, 33 patients with non-Hodgkin's lymphoma of the small bowel were analyzed retrospectively. The Ann Arbor stages were: ⅠE 12, ⅡE 15 and Ⅳ E 6. The histological subtypes were: T-cell lymphoma 1 and B-cell lymphomas 32. A ll the patients received surgical treatment including radical or palliative rese ction. Twenty-six patients received postoperative radiotherapy including strip -f ield technique in 12 and opposed anterior-posterior fields in 14, with a median dose of 2543.5?cGy. Postoperative chemotherapy were applied to all patients inclu ding CHOP regimen in 17, COMP regimen in 6, COP regimen in 3, MINE regimen in 2, COPP regimen in 3 and BACOP regimen in 2. The median number of cycle was 4. Results The overall 5-year survival rate and disease-free survival rate were 48% and 39%. The 5-year survival rates were: ⅠE stage 42%, ⅡE stage 67% and ⅣE s tage 17%, respectively. Conclusions Most of the primary non-Hodgkin's lymphoma of the small intestine are in stage ⅠE and ⅡE, and the intermediate-grade and h igh-grade pathological subtypes are predominant. Surgery based combined treatme n t is effective and is advised. Radiotherapy and chemotherapy may improve the sur vival.