原发性胃肠道淋巴瘤诊治

Diagnosis and Therapy of Primary Gastrointrestinal Lymphoma

目的探讨原发性胃肠遭淋巴瘤（PGIL）的临床病理特点、内镜诊断及治疗预后，以提高诊治水平。方法回顾性分析我院2000年1月～2006年4月经胃镜活检或手术病理证实的29例PGIL的临床资料。结果29例PGIL在胃21例，结肠6例、小肠2例。病理类型属MALT淋巴瘤者8例，弥漫大B细胞淋巴瘤者18例，T细胞型淋巴瘤3例。临床症状依次为腹痛、贫血、腹胀、黑便或便血、体重减轻等。27例胃、结肠淋巴瘤内镜下表现为弥漫浸润型11例、溃疡型10例、结节型6例，经首次内镜常规活检诊断9例（33．33％）。手术加化疗10例，单纯化疗19例，随访至今手术组目前尚存者6例（存活率60％），单纯化疗目前尚存者13例（存活率68．42％），差异无统计学意义。结论PGIL发病部位以胃部为主；病理类型以弥漫大B细胞淋巴瘤为主；临床症状无特异性，以腹痛为主；首次内镜常规活检诊断率低，提高认识，多次深挖式活检可提高诊断率；对术前能明确诊断者，首选化疗。

Objective To study the clinical and pathologic features, and endoscopic diagnosis as well as therapy and prognosis of the primary gastrointrestinal lymphoma （PGIL）, and to improve its diagnosis and therapy efficiency. Methods The clinical data in 29 cases of PGIL were retrospectively reviewed. Results In these cases, the tumor was mainly located at stomach （n = 21）, colon （n = 6） and small intestine （n = 2）. The type of pathology was mucosa associated lymphoid tissue lymphoma （n = 8）, diffuse large B - cell lymphoma （n = 18）, T - cell lymphoma （n = 3）. The commom manifestation include abdominal pain, anaemia, abdominal distention, melena or hemafecia, loss of weigh etc. The tumor appeared infilitrative in 11 cases, ulcerative in 10 cases, protruding in 6 cases, 9 cases were diagnosed by firstly routine biopsy endoscopiccally. 10 cases were treated by operation and chemotherapy, 19 cases were treated by chemotherapy. Up to now, 6 cases survival in operation group, 13 cases survival in chemotherapy group, the difference was not statistically significant. Conclusions PGIL was mainly located at stomach, which was not specific clinical manifestation; The type of pathology was mainly diffuse large B - cell lymphoma; the diagnositic rate of routine endoscopic biopsy was low. chemotherapy was the first treatment of PGIL.