胃肠道恶性淋巴瘤的诊断与治疗

Diagnosis and treatment of the prirmary gastrointestinal non Hodkins's lymphomas

目的探讨胃肠道恶性淋巴瘤的诊治方法。方法对２４例胃肠道淋巴瘤资料进行了回顾性分析。结果小肠淋巴瘤１３例，３例术前在ＣＴ引导下活检确诊，１１例钡餐检查８例异常；胃淋巴瘤６例与结肠淋巴瘤５例均为术前内窥镜下活检确诊。Ｂ超检查２２例，１４例阳性；ＣＴ检查１７例，１４例阳性。２３例行手术治疗辅佐ＣＨＯＰＥ化疗，有效率９５８％。术后全部病例均获随访，随访时间为１～１４年，５年生存率为６６７％。Ⅱ，Ⅲ期９例术后６～２３月复发，５例死于复发与并发症。结论内窥镜下活检或ＣＴ引导下活检最具确诊价值，消化道钡餐对诊断有所帮助。治疗以手术作为首选，辅佐化疗，以ＣＨＯＰＥ方案为佳。

Objective To search the effective methods of diagnosis and therapy for gastrointestinal lymphoma (GIL). Methods The clinical data of 24 patients with primary gastrointestinal non Hodykin's lymphomas were respectively analyzed. Results Only 3 of the 13 patients with small intestinal lymphomas were correctly diagnosed by biopsy under computer tomography (CT) guide and 8 cases abnormal in X ray examination; all of the 6 cases of gastric lymphomas and 5 cases of colonic lymphomas were diagnosed correctly by biopsy under endoscopy before operation. The positive diagnosis rate was 14/17 by CT scan and 14/22 by ultrasonography. Twenty three cases were treated with operation followed by CHOPE chemotherapy, the effective rate was 95.8%. All of the patients have been followed up for 1～14 years, the 5 years survival rate was 66.7%. Nine cases of the stage Ⅱ or stage Ⅲ relapsed at 6～23 months after operation and 5 cases died from relapse and complications. Conclusions Using biopsy under endoscopy or CT guide is the most valuable method for the diagnosis of GIL, and X ray examination is helpful to the preoperative diagnosis of GIL. Surgery with CHOPE chemotherapy or radiotherapy is the best choice of treatment.