喉原发性恶性淋巴瘤的诊断治疗(附11例报告)

Diagnosis and treatment of primary laryngeal lymphoma:a report of 11 cases

目的根据１１例原发于喉的恶性淋巴瘤的病例，结合文献探讨分析该病的诊断、治疗及预后。材料与方法１９７１～１９９５年共收治１１例原发于喉的恶性淋巴瘤，其主要临床表现为声嘶、咽喉痛、吞咽痛、进食异物感、吞咽困难等。间接喉镜或纤维导光镜可见声门上区或声门区肿物，肿物形态不一，可为息肉样、结节样、粘膜光滑性肿物或仅为坏死糜烂性改变。所有病例均经病理证实为非霍奇金淋巴瘤（Ｎｏｎ－Ｈｏｄｇｋｉｎ’ｓｌｙｍｐｈｏｍａ，ＮＨＬ），确诊后均行放疗，６～８ＭＶＸ线，局部野２例，扩大野９例，ＤＴ５０～７０Ｇｙ，中位ＤＴ５５Ｇｙ，放疗后均未行预防性化疗。结果全部病人疗后随访１８～１８０月，其中７例无病生存１８～１８０月，４例于疗后９～１２０月复发，均位于照射野外，２例因不能接受有效化疗死亡，２例接受正规放、化疗至今已分别无瘤生存３６月、６０月。结论原发于喉的恶性淋巴瘤少见，临床上容易误诊，确诊有赖于病理证实。放疗的局部控制作用良好，即使复发，积极治疗仍有治愈的可能。

Purpose This article is to evaluate the diagnosis ,treatment and prognosis of primary laryngeal lymphomas.Materials and Methods From 1971 to 1995,11 cases of primary laryngeal lymphoma were treated in our hospital. The common symptoms were hoarseness, odynphagia, dysphagia and so on. Using the laryngoscopy or fibroscopy, smooth mucosal mass, nodule mass, polyp mass or necrotic change can be seen in the supraglottic or glottic regions. Pistopathological diagnosis was NonHodgkin's lymphoma. Radiotherapy was given to the patients after diagnosis using 6～8 MVX rays, small irradiation fields for 2 cases, extended fields irradiation for 9 cases. Total tumor doses were 50～70Gy and the median dose was 55Gy. Adjuvant chemotherapy were not given to all the patients.Results Seven patients after radiotherapy had survived 18 to 180 months without evidence of tumor , but 4 patients had extrairradiation field recurrence from 9 to 120 months after radiotherapy. Of them,two patients died of recurrences due to low dose irregular chemotherapy , and 2 patients were saved by regular chemotherapy and radiotherapy.Conclusion Primary laryngeal lymphoma is a rare disease and difficult to be diagnosed. All patients after diagnosis should be treated by radiotherapy and will be controlled locally by radiotherapy.The prognosis is good ,even if some of them had recurrence after radiotherapy alone,they can still be cured by combined treatment of chemotherapy and radiotherapy.