157例胃原发性非霍奇金恶性淋巴瘤的诊治

Diagnosis and treatment of primary gastric non-Hodgkin′s lymphoma: analysis of 157 patients

目的 探讨原发性胃非霍奇金恶性淋巴瘤的外科诊治经验及影响预后的因素。 方法对 4 5年间外科治疗的 15 7例原发性胃非霍奇金恶性淋巴瘤进行回顾性分析。 结果 术前X线诊断率为 39 4 % ,胃镜确诊率为 5 2 7% ,ⅠE 期 32例 ,ⅡE 期 4 0例 ,ⅢE 期 2 9例 ,ⅣE 期 5 6例。术后辅以化、放疗。患者总的 3、5、10、15年生存率分别为 5 1 1% (6 9/135 )、4 2 3% (5 5 /130 )、2 0 7% (2 3/111)、13 5 % (14 /10 4 )。手术切除组的 3、5年生存率分别为 6 0 2 % (6 5 /10 8)和 5 0 0 % (5 2 /10 4 )。ⅠE、ⅡE 期3、5年生存率是ⅢE、ⅣE 期的 2～ 5倍 (χ2 检验分别为 6 6 37、92 183,且均P <0 0 1)。手术切除组 5年生存率 5 0 0 %高于胃癌根治术 5年生存率 33 3%。 结论 早期诊断、早期外科手术治疗是原发性胃非霍奇金恶性淋巴瘤治疗中预防并发症 ,提高生活质量 ,延长生存期的关键有效的治疗手段。

Objective To seek the optimum treatment for patients with primary gastric non Hodgkin′s lymphoma and factors associated with prognosis. Methods A retrospective study was conducted on 157 primary gastric non Hodgkin′s lymphoma patients who had received operation for 45 years. Results The X ray diagnosis rate was 39 4% before operation. The diagnosis rate by gastroscopy was 52.7% Among the 157 patients, 32 belonged to stage Ⅰ E , 40 stage Ⅱ E, 29 stage Ⅲ E, and 56 stage Ⅳ E. All of the patients were received chemotherapy or radiation. The 3 ,5 ,10 ,15 year survival rates were 51 1%(69/135), 42 3%(55/130), 20 7%(23/111), and 13 5%(14/104). Conclusions The 3 ,5 year survival rates in stageⅠ E and stage Ⅱ E were 2 to 5 times higher than those in stage Ⅲ E and Ⅳ E ( P <0 01). The 3 ,5 year survival rates of primary gastric non Hodgkin′s lymphoma were 60 2%(65/108) and 50 0%(52/104) respectively. The prognosis was better than the 5 year survival rate of gastric cancer patients with D 2 lymphodenectomy (33 3%). Early diagnosis and treatment are effective to prevent complications, enhance quality of patient′s life, and prolong the survival.