鼻咽恶性淋巴瘤(附98例临床分析)

MALIGNANT LYMPHOMA OF THE NASOPHARYNX (CLINICAL ANALYSIS OF 98 CASES)

本文收集我院1965年3月至1987年12月鼻咽恶性淋巴瘤98例,其中何杰金氏淋巴瘤(简称HD)12例(12.24％),非何杰金氏淋巴瘤(简称NHL)86例(87.76％)。男67例,女31例。临床主要症状为头痛、鼻塞,涕血、耳鸣及颈部肿块。颈淋巴结转移率74.48％。颅底骨及颅神经受累仅5例(5.10％)。临床分期中Ⅰ期15例、Ⅱ期45例、Ⅲ期9例、Ⅳ期27例、未能分期2例。采用单纯放疗、单纯化疗及综合治疗。经随访满5年以上者76例,3年及5年生存率HD为81.82％(9/11)和54.54％(6/11),NHL为29.23％(19/65)和26.15％(17/65)。其中以综合治疗效果较好。治疗后鼻咽及颈部淋巴复发者3例(3.16％),远处转移36例(37.89％),远转部位以腹部包块最多见(15例,占转移病例38.46％)。复发或转移时间多在治疗1年内。影响预后的因素除病理类型及治疗方法外,病期愈早预后愈好,有全身症状者及儿童预后差。目前我们施行以CHOPB方案的化疗加放疗的综合治疗。

98 cases of malignant lymphoma of the nasopharynx in tumor hospital of SUMS from Much, 1965 to December, 1987, were analysed including 12 cases of Hodgk in's disease (HD, 12.24%) and 86 cases of non-Hodgkin's lymphoma (NHL, 87.76%) . Among them 67 were males and 31 were females. The common symptoms were headache, nasal obstruction, epistaxis, tinnitus and cervical lumps. In this series, cervical lymph node metastasis accounted for 74.48% ,and in 5 cases (5.10%) the base of the skull and cranial nerves were involved. Among the patients 15 were in stage Ⅰ, 45 in stage Ⅱ, 9 in Ⅲ, and 27 in stage Ⅳ respectively, staging of 2 cases were undefin ed. Radiotherapy, chemotherapy and the multimodality treatment were performed.76 cases have been followed up for five years. The 3-and 5-year survival rates were 81.82% (9/11) and 54.55% (6/11) for HD, 29.23%(19/65)and 26.15% (17.65) for NHL, respectively.Recurrence in the nasopharynx and cervical lymph nodes accounted for 3.16% (3 cases), while the distant metastasis (36 cases 37.89%) occurred mostly with in 1 year. The distant metastasis was mostly seen in the abdomen (15 cases, accounts for 38.4%) . The prognosis is poor in patients with general symptoms and in childhood. A-ccording to our experience, the best treatment for this disease is chemotherapy with CH-OPB regimen prior to radiation.