原发性脾脏恶性淋巴瘤的术后治疗

Postoperative Treatment of Primary Splenic Lymphoma

目的 探讨原发性脾脏恶性淋巴瘤的术后治疗方法.方法 选取2004年5月至2012年8月南昌大学第一附属医院收治的术后原发性脾脏恶性淋巴瘤14例.14例中7例进行了超声检查,12例进行了CT检查.10例行开腹脾切除术,4例行腹腔镜脾切除术.结果 术后单纯CHOP方案化疗11例,R-CHOP方案化疗2例,CHOP方案化疗加腹部放疗1例,放疗剂量Dt 40 Gy·4周-1.化疗周期数为4～8周期.按Ahmann分期,Ⅰ期5例、Ⅱ期2例、Ⅲ期7例.随访时间8～101个月,14例患者中,有6例出现复发或转移,首次出现复发或转移部位有纵隔1例,肝门区2例,脾区1例,脾区及腹膜后1例,颈部1例,其中已死亡3例,另11例患者仍存活.本组中位无瘤生存时间为8个月,中位总生存时间为27个月.结论 原发性脾脏恶性淋巴瘤术后治疗应以化疗为主,对来源于B细胞者加用利妥昔单抗有可能提高疗效.对Ⅰ期、Ⅱ期病例加用腹部放疗是否有利需扩大病例进一步观察研究,但要注意到原发性脾脏恶性淋巴瘤术后复发或转移的比例高,且部位具有广泛性及不确定性.

Objective To investigate the postoperative treatment of primary splenic lymphoma （PSL）. Methods Fourteen PSL patients admitted to the first affiliated hospital of Nanchang uni- versity between May 2004 and August 2012 were selected in this study. Among the 14 patients, ultrasonography was performed in 7,CT in 12,open splenectomy in 10,and laparoscopic splenec- tomy in 4. Results After operation,CHOP chemotherapy was carried out in 11 patients,R-CHOP chemotherapy in 2, and CHOP chemotherapy plus abdominal radiotherapy （Dt 40 Gy ~ 4 weeks-＇ ） in 1. Patients were assessed after 4-8 cycles of chemotherapy. According to Ahmann cri- teria,PSL was staged as stage I in 5 cases,stageH in 2,and stage ~ in 7. After 8-101 months of follow-up, 6 of the 14 patients had recurrence or metastasis,which occurred in mediastinum in 2, hepatic hilum in 1, spleen in 1, spleen and retroperitoneum in 1, and neck in 1. In addition, 3 pa- tients died of tumor recurrence or metastasis and other 11 patients survived. The median disease- free survival time was 8 months and the median overall survival time was 27 months. Conclusion The chemotherapy is the main postoperative treatment of PSL. Rituximab may enhance the cura- tive effect of chemotherapy for patients with B-cell lymphoma. Adjuvant effect of abdominal ra- diotherapy on stage I and II PSL needs further investigation. However, a considerable propor- tion of postoperative recurrence or extensive and uncertain metastasis should be noticed in pa- tients with PSL.