外科手术在原发性胃肠道非霍奇金淋巴瘤诊治中的作用

Effect of Surgical Treatment on Primary Gastrointestinal Non-Hodgking Lymphoma in Children

目的探讨外科手术在儿童原发性胃肠道非霍奇金淋巴瘤(NHL)诊断、治疗中的作用。方法回顾性分析本院收治的9例儿童原发性胃肠道NHL的临床及随访资料,对儿童原发性胃肠道NHL的外科诊治及疗效进行临床总结分析。结果本组病例中男7例,女2例;年龄(5.59±3.27)岁。9例均经术后病理证实为胃肠道NHL,其中临床表现为腹部肿块7例,腹痛5例,发热3例,呕血黑便2例,便秘、阵发性腹痛伴呕吐各1例。诊断为肠套叠、急性阑尾炎、肠梗阻肠穿孔、十二指肠梗阻各1例,消化道出血2例,腹腔占位3例。1例行肠套叠复位术加肿瘤切除加末端回肠升结肠吻合术;1例行阑尾切除术;1例行肿瘤活检术加横结肠造瘘术;6例行剖腹探查术。病理检查示6例为Burkitt淋巴瘤,2例为弥散性大B细胞性淋巴瘤,1例为间变性大细胞性淋巴瘤,其中Ⅰ期、ⅠE期各1例,Ⅱ期2例,ⅡE期3例,Ⅲ期2例。9例均行手术治疗,1例术后死亡,8例术后均恢复良好,且经不同疗程化疗后1、3a生存率分别为75.0%及37.5%。结论儿童胃肠道NHL常以急腹症为首发症状,经外科手术、化疗等综合治疗可获得良好疗效。

Objective To explore the effect of surgical treatment on primary gastrointestinal non-Hodgking lymphoma（NHL） in children.Methods Nine cases of clinical and follow-up data of primary gastrointestinal NHL were studied retrospectively to evaluate the effect of surgical treatment on primary gastrointestinal NHL in children.Results Seven cases were male and 2 cases were female.The mean age was（5.59±3.27）years old.The clinical manifestation included abdominal mass （7 cases）,abdominal pain （5 cases）,fever （2 cases）,haematemesis and melena （2 cases）,constipation （1 case） and paroxysmal abdominal pain with vomiting （1 case）.Nine cases were diagnosed as primary gastrointestinal NHL,including 1 case of intussusception,1 case of acute appendicitis,2 cases of gastrointestinal obstruction,2 cases of gastrointestinal bleeding and 3 cases of abdominal mass.One case received the operation of intussusception reduction,tumor resection and intestinal anastomosis.One case received appendectomy.One case received the operation of tumor biopsy and transverse colon colostomy.Six cases received laparotomy.Six cases were diagnosed as Burkitt lymphoma.One case was anaplastic large cell lymphoma and 2 cases were diffuse large B-cell lymphoma.One case was at stage Ⅰ,1 case was at stage ⅠE,2 cases were at stage Ⅱ,3 cases were at stage ⅡE and 2 cases were at stage Ⅲ.Nine patients had received operation.One case died after operation and 8 cases had received combined chemotherapy.The 1 and 3 years survival rates were 75.0% and 37.5%,respectively.Conclusions Acute abdomen is often the first symptom of primary gastrointestinal NHL in children and comprehensive surgical treatment is an effective procedure for it.