胃淋巴瘤与胃腺癌的临床病理对比研究

Comparative study of gastric lymphoma and gastric adenocarcinoma

目的对比研究原发性胃淋巴瘤(primary gastric lymphoma,PGL)与胃腺癌(gastric adenocarcinoma,GA)临床及病理特征,以期增进对该疾病的临床诊治。方法对49例原发性胃淋巴瘤和200例胃癌患者比较其年龄、发病时间、临床症状、肿块部位、内镜及大体分型、幽门螺杆菌(Helicobacter pylori,Hp)感染及组织病理学等临床资料,并详细分析12例早期胃淋巴瘤的临床病理资料。结果 49例PGL和200例GA组患者,均表现为腹痛、腹部不适和上消化道出血等非特异性症状。PGL多发于胃体及胃窦,病灶常为多发溃疡或巨大结节,GA组病灶以胃窦部为主,常呈单发溃疡;PGL组的Hp感染率显著高于胃癌组(P<0.05);PGL术前诊断率显著低于GA组(P<0.05)。12例早期PGL患者中,8例为Ⅱc型病变,治疗效果较好。结论内镜检查示胃黏膜有多发糜烂溃疡时,应考虑PGL可能。早期PGL确诊后通过手术、化疗或根除Hp治疗,预后良好。

Objective To comparatively study the clinical and pathological features of primary gastric lymphoma（ PGL） and gastric adenocarcinoma（ GA）. Methods The clinical manifestations,onset of age,endoscopic or morphologic classification,infection of Helicobacter pylori（ Hp） and histopathologic features of 49 PGL and 200 GA patients were analyzed. Analysis of 12 early-stage PGL patients were focused on endoscopic and histopathologic features,treatments and outcomes. Results Both PGL and GA patients had nonspecific clinical manifestations as abdominal pain,discomfort and upper gastrointestinal bleeding. The masses of PGL patients often located in corpus and antrum. Multiple ulcers or huge mass were observed in most PGL patients,compared to single ulcer observed in GA patients. The ratio of Hp infection in PGL group was higher than that in GA group（ P〈0. 05）. Accuracy of diagnosis before operation in PGL group was lower than that in GA group（ P〈0. 05）. Eight of 12 early-stage PGL patients presented type Ⅱc lesions with good outcomes.Conclusion Diagnosis of PGL should be considered when multiple erosions or ulcers were observed. Early-stage PGL has a good prognosis with optimal treatment of surgery,chemotherapy or eradication of Hp.