原发性胃恶性淋巴瘤的临床分析

The Clinical Analysis of Primary Gastric Malignant Lymphoma

目的探讨原发性胃恶性淋巴瘤的临床特点及其与幽门螺杆菌感染的关系。方法对31例原发性胃恶性淋巴瘤的临床病理、免疫组化及幽门螺杆菌感染的结果进行分析。结果患者有上腹不适、肿块、黑便或贫血等临床表现。31例中原发于胃底3例,胃体6例,胃角9例,胃窦13例。18例术前经胃镜活检确诊;所有病例做免疫组化染色及幽门螺杆菌监测,证实为B细胞型淋巴瘤29例,T细胞型淋巴瘤3例,幽门螺杆菌感染率为90.2%。全部病例均行手术治疗及术后辅助化疗。29例获得随访,5年生存率为45.1%。结论原发性胃恶性淋巴瘤多属B细胞来源,并且与幽门螺杆菌感染有关。胃镜检查是术前最有效诊断价值的方法之一。手术方式与胃癌相似,术后化疗与手术治疗同等重要,病理类型是判断预后的重要指标之一。

Objective To investigate the relationship between the clinical characteristics of primary gastric malignant lymphoma and Helicobacter Pylori （H. P） infection. Methods The clinical, pathological and immunohistochemical characteristics and H. P infection of 31 patients with primary gastric lymphoma were analyzed, Results The main clinical mainfestations included epigastric discomfort, abdominal mass, haematochezia and anemia. Among the 31 cases,3 cases arose from fundus of stomach ,6 cases from bady of stomach ,9 cases from gastric angle and 13 cases from gastric antrum. All the patients were diagnosed by histopathological and immunohistochemical studies, among which 18 were diagnosed by gastroscopy guided biopsy before operation, H, P infection was studied in all patients, 29 cases exhibited B-cell phenotype and 3 patients exhibited T-cell phenotype by immunohistochemistry. H, P infection was noted in 90.2% of patients. All patients were treated by surgical resection of the primary tumor and post-operative chemotherapy. Follow-up was complete in 29 patients, The 5-year survival rate was 45.1%, Conclusion Most primary gastric malignant lymphoma are H, P infection related, B-cell lymphomas. Gastroscope guided biopsy is the useful diagnostic means before surgical resection. Postoperative chemotherapy is as important as surgical treatment. Pathological type was an important indication for evaluation of prognosis,