口腔颌面颈部恶性淋巴瘤56例临床分析

Clinical Analysis of Malignant Lymphoma in Oral and Maxillofacial Region and Neck

目的:探讨头颈部恶性淋巴瘤的发病特点、临床表现以及预后的相关性分析。方法:搜集56例头颈部恶性淋巴瘤病例,采用HE染色法进行观察,分析临床特点及预后情况。结果:56例头颈部恶性淋巴瘤患者中非霍奇金恶性淋巴瘤和霍奇金恶性淋巴瘤患者分别为47例(83.93%)和9例(16.07%),常见临床体征是包块(痛性及无痛性),感染溃疡。49例回访,7例失访。在回访中,22例(44.90%)复发,经分析表明复发率与患者的年龄及累计部位的差异具有统计学意义(P<0.05)。发病部位依次为颈部、颌下、颏下。仅有头颈部症状者48例(85.71%)。初次诊断不明确者46例(82.14%)。1次病理诊断的确诊率为84.8%。治疗主要为手术+化疗。患者5年生存率58%。结论:结外型恶性淋巴瘤的临床表现及组织学形态多样化,容易与临床上其他疾病相混淆。应通过病理检查及免疫组织化学检查以明确诊断。累犯≥2个部位和年龄>50岁头颈部恶性淋巴瘤患者的复发率较高。

Objective： To investigate the correlation analysis of clinical characters,prevalence and prognosis of malignant lymphoma（ML）in oral and maxillofacial region and neck. Methods： We collected 56 cases of oral and maxil- lofacial region and neck malignant lymphoma, observed them by HE staining, analysed clinical features and prognosis. Results： Among 56 patients with ML, 47 cases were Non Hodgkin＇s lymphomas（NHL） and 9 cases were Hodgkin＇s lymphomas（HL）. The common clinical signs were tumour（painless or pain）, infection and ulcer respectively. Follow--up data were available in 49 cases, 7 cases were not available. 22 cases （44.90%） relapsed in return visit. The analysis showed that the difference was statistically significant （P〈0.05） between the recurrence rate, patienfs age and accumulated parts. The diseasedparts were neck, submaxillary region, and submental region. There were 48 cases in oral and maxillofacial region and neck （85.71%）. The first diagnosis of 46 patients was indefinable. The rate of first pathological diagnosis was 84.4 %. The main treatments were multimodal therapy（chemotherapy and operations） . The five--year survival rate was 58%. Conclusion： The clinical manifestation and histological morphology of extranodal malignant lymphoma was variform,which easily confused with other diseases. Biopsy and immunohistochemistry is necessary in definitive diagnose of malignant lymphoma（ML） . The patients of head and neck malignant lymphoma that involving the two parts and more than 50 years old were relatively high recurrence rate.