原发性胃淋巴瘤的临床和内镜下表现

Clinical and endoscopic features of primary gastric lymphoma

目的探讨原发性胃淋巴瘤的临床和内镜下表现特征及其内在联系.方法总结1993年1月～2004年4月该院经手术与病理证实的24例原发性胃淋巴瘤患者的临床、内镜和病理资料.结果24例患者临床表现无特异性,临床误诊率高(91.7%).病变主要在胃体和胃窦,同时累及胃体胃窦部10例,局限于胃体部9例,胃窦部4例,胃底部1例.形态表现多样,溃疡型18例;弥漫型4例;结节型2例.内镜活检确诊率低(41.7%).病理以B细胞为主.H.pylori感染率为83.3%.结论原发性胃淋巴瘤临床表现无特异性,内镜下病变范围广、病灶多发为其特点,内镜下多点、多块深取检以及及时行免疫组化检查可提高诊断准确率.H.pylori感染可能与胃淋巴瘤的发生有关.

[Objective ] To explore the clinical and endoscopic features of primary gastric lymphoma. [Methods] The clinical, endoscopic and pathologic data of 24 patients with primary gastric lymphoma identified by histology were analgzed. [Results] The symptoms were not characteristic. Upper abdominal pain was most common. Misdiagnosis rate was 91.7%.The tumor originated from antrum and corpus in 10 cases, corpus 9, antrum 4, fundus 1. The tumor appeared ulcerative in 18 cases, in filtrative 4, nodular 2. The detection rate of endoscopic biopsy was very low （41.7%） Immunohistochemistry showed B-cell lymphoma in mostly case. Helicobacter pylofi （H.pylori） infection was found in 20 case （83.3%）. [Conclusions] Noclinical symptoms and signs have been found specific for the diagnosis of primary gastric lymphoma. The endoscopic features are variegated and the lesion is more extensive. Multipoint biopsy and deep biopsy can improve confirmed diagnosis rate. H.pylori infection may play a role in the pathogenesis of primary gastric lymphoma.