20例原发性胃恶性淋巴瘤的胃镜诊断和临床分析

Clinical analysis and gastroscopic diagnosis of primary gastric malignant lymphoma

目的对原发性胃恶性淋巴瘤的胃镜下形态特征和临床特点进行分析,探讨胃镜对原发性胃恶性淋巴瘤的诊断价值。方法回顾性分析20例原发性胃恶性淋巴瘤的一般资料、临床表现、CT征像、内镜特征及病理。结果原发性胃恶性淋巴瘤发病大于40岁的人群比例较高,达70%。临床症状无特征性表现,以上腹痛和上消化道出血为主。CT征像表现为局限增厚型、局限肿块型、弥漫增厚型和未见异常型。胃镜缺乏特异性表现,形态具有多样性,主要表现为溃疡型、肿物型和小结节型等。难于同胃癌等其他胃部疾病鉴别。全部病理结果均为B细胞非霍奇金淋巴瘤。结论原发性胃恶性淋巴瘤临床表现和CT征像均缺乏特异性。胃镜下形态特征具有多样性。胃镜下多点取材和深度活检可提高胃镜诊断的阳性率。

Objective To investigate gastroscopic diagnostic value for the primary gastric malignant lymphoma by analyzing the gastroscopic shapes and clinical features.Methods The general information,the clinical manifestations,the CT signs,the endoscopic features and pathologies of primary gastric malignant lymphoma were analyzed retrospectively.Results In 20 cases of the primary gastric malignant lymphoma：there was a higher proportion in the beyond 40-year-old crowd,amounting to 70%;their clinical symptoms were not characteristic,which manifestations mainly had abdominal pain and upper gastrointestinal bleeding.The primary gastric malignant lymphoma was divided into diffuse thickening type,segmental thickening type,mass of the gastric wall type and normal type by CT appearances.The gastroscopic shapes lacked the specific performance,which features mainly were ulcer,bump and nodule.It was difficult to identify the primary gastric malignant lymphoma with the gastric cancer and other stomach diseases.All pathological results were the B cell non-Hodgkin′s lymphoma.Conclusion The clinical manifestations and the CT signs of primary gastric malignant lymphoma are no characteristic.The gastroscopic shapes are multifarious.Multi-point based and deep biopsy can increase the positive rate of diagnostic endoscopy.