原发性小肠淋巴瘤的临床诊治

Experience of the diagnosis and treatment of primary small intestine lymphoma

目的探讨原发性小肠淋巴瘤（PSIL）的临床诊治方法。方法回顾性分析2003年1月至2007年7月收治的15例PSIL患者的临床资料，其中男性9例，女性6例，年龄18～73岁，平均51．6岁。按发病性别、年龄、临床表现、实验室检查、影像学检查、诊断、治疗方法等项目进行分析。结果15例患者常见的临床表现为腹痛、腹部肿物、肠梗阻、消化道出血及消瘦，血清肿瘤学指标均正常。15例均接受螺旋CT检查，检出肿瘤15例，提示PSIL12例；11例行消化道钡餐检查，4例检出病变，1例提示PSIL可能。15例患者均行手术治疗，术后病理检查结果：15例均为非霍奇金淋巴瘤（NHL），其中弥漫性大B细胞性NHL8例，黏膜相关淋巴组织B细胞性NHL5例，肠病相关T细胞性NHL2例。术后发生应激性溃疡1例，无围手术期死亡。术后10例患者接受辅助化疗，方案为CHOP（环磷酰胺＋表柔比星＋长春新碱＋泼尼松）。术后14例获得随访，平均随访30个月（6～52个月），6例死于肿瘤转移或复发。1、3年生存率分别为85．7％、57．1％。结论PSIL仅靠临床表现不易确诊，消化道钡餐诊断率低，螺旋CT是较好的早期诊断方法，结合临床具有较高的诊断价值。手术结合化疗是治疗PSIL的重要手段。

Objective To report the experiences of the diagnosis and treatment of primary lymphoma of the small intestine（PSIL）. Methods The clinical data of 15 patients with PSIL treated from January 2003 to July 2007 was investigated retrospectively. Of the 15 cases, 9 patients were male and 6 were female, the average age was 51.6 years （ range, 18-73 years）. Data of gender, age, clinical manifestation, laboratory examination, imageology examination, diagnosis and treatment of the patients was reviewed. Results The most common clinical manifestations were as follow： abdominal pain, abdominal lump, bowel obstruction, gastrointestinal hemorrhage and athrepsy. Serum tumor markers were checked normal. All the 15 cases were found with tumor by spiral CT, and 12 cases were diagnosed as PSIL. Eleven cases were given Ba-meal examinations, and positive results was found in 4 cases, and only 1 case was considered to be PSIL. All the 15 patients received operation. All the patients were diagnosed as non-Hodgkin lymphoma （NHL） by postoperative pathology （8 patients as diffuse large B-cell lymphoma, 5 as mucosa associated lymphoid tissue type B cell lymphoma and 2 as enteropathy-type intestinal T cell lymphoma）. No perioperative death occured. Ten patients received adjuvant chemotherapy with the regimen of CHOP （cyclophosphamide ＋ epirubicin ＋ vincristine ＋ prednisone） after the operation. Fourteen cases were followed-up for a mean time of 30 months （range, 6-52 months）. The 1- and 3-years survival rate was 85.7% and 57.1%, respectively. Conclusions PSIL has no specific clinical manifestations, the diagnostic rate with barium study is low, spiral CT scan is a promising diagnostic method for PSIL. Operation combined with chemotherapy is important for PSIL.