38例肠道症状为主要表现的T/NK细胞非霍奇金淋巴瘤的临床分析

Clinical Analysis and Endoscopic Characteristic of 38 Cases of T/NK Cell non-Hodgkin’s Lymphoma with Intestinal Symptoms

目的分析以肠道症状就诊的T/NK细胞非霍奇金淋巴瘤(NHL)的临床和内镜特点,以提高对该疾病的认识。方法总结回顾本院38例以肠道症状就诊的T/NK细胞NHL病例临床资料,分析其临床和内镜特点。结果肠道主要首发症状为单纯腹痛或腹胀/腹部不适(11例)、腹痛伴有便血(12例)、腹痛伴有腹泻(11例)、腹痛伴腹部包块(2例)、黑便(2例)。有B症状者30例,IPI评分为高危和高中危的患者33例。约一半患者LDH、ESR、CRP增高。31例患者行手术,主要原因为穿孔(19例)。病变累及大肠12例,小肠15例,回盲部7例,小肠和大肠均受累4例。病变类型中多发弥漫溃疡为12例,局限性溃疡10例,肿块/占位11例,黏膜病变4例,其他病变1例。病理类型以周围T细胞淋巴瘤-非特指型(PTCL-U)多见。对于原发肠道T/NK细胞性NHL,病变累及大肠10例,回盲部3例,小肠8例,多部位受累3例;病变类型以多发弥漫溃疡型为主(9例)。结论 T/NK细胞淋巴瘤在小肠和大肠均常见,病变类型以多发弥漫溃疡和占位为主。临床工作中对以腹痛为主要表现,伴有B症状、LDH、ESR、CRP增高,病情进展快的患者,应警惕T/NK-NHL的可能,争取早期确诊。

Objective To improve the understanding of the clinical and endoscopic characteristics of T/NK findings of 38 patients with T/NK cell lymphoma in intestine were reviewed. Results The initial presenting symptoms of T/NK cell lyrephoma with intestinal lesions were abdominal pain or distention （11 cases ） ,with intestinal bleeding （12 cases ） , with diarrhea （11 eases）,with abdominal mass （2 cases） and melana （2 cases） with elevation of LDH,ESR and CRP in half of the patients. 31 patients had surgery during the ourse,of whom 19 patients were due to perforation. The anatomic location of the lesion was found to be ： colorectum （ 12 cases） ; jejunoileum （ 11 cases） ; ileocecal （7 cases） ; duodenum （ 3 cases） , both small sion was found to be ： coloreetum （ 12 cases） ; jejunoileum （ 11 cases） ; ileocecal （7 cases） ; duodenum （ 3 cases） , both small and large intestine （4 cases）. And the lesions were multiple diffuse ulcerative in 12 cases （31.6%） ,confined ulcerative in 10 cases （26.3%）, tumorous in 11 cases （28.9%）, mucosal in 4 cases （ 10.5 % ）. For ITCL, the involved sites were large intestine （10 cases） , ileocecal region （3 cases）, small intestine （8 cases） , and multiple sites （3 cases） ;and the lesion types were mainly ulcerative （ 16 cases）, especially in multiple diffuse ulcerative （9 cases）. Conclusion T/NK cell lymphoma involving intestine was mainly in the large intestine and the small intestine, with multiple diffuse ulcerative and tumorous lesions being the most common types. ITCL was mainly in the large intestine with a lesion type of multiple diffuse ulcerative.