Castleman病19例诊断与外科治疗

Diagnasis and surgical treatment of Castleman disease

目的 Castleman病(Castleman disease,CD)是一种原因未明的反应性淋巴结病,目前报道较少,临床诊疗过程中容易误诊误治。本研究探讨19例CD的临床特点及手术疗效,结合复习相关文献,以提高对CD的诊治水平。方法回顾性分析云南省肿瘤医院2000-08-10-2014-08-10收治的19例局灶性CD患者的临床及随访资料,总结其临床特点、病理类型、治疗方式和疗效。治疗前后细胞白介素6(interleukin-6,IL-6)水平采用配对t检验进行比较。结果19例局灶性CD患者入组,其中男8例,女11例,男女比例为0.73∶1;年龄16~41岁,平均年龄24.8岁。首发症状均为无痛性颈部肿块,无全身症状。肿块位于颈部Ⅴ区11例,颈侧区(Ⅱ~Ⅳ区)8例,Ⅱ区Ⅲ区1例,Ⅲ区Ⅳ区1例,Ⅱ区Ⅲ区Ⅳ区2例。肿块大小2.5~8.5cm,平均3.5cm。均行肿物切除术,17例完整切除,2例部分切除,术后病检均为透明血管型。随访1~129个月,中位随访时间25个月,现均生存,其中4例患者肿瘤复发带瘤生存。患者的年龄、肿块大小和血液中IL-6水平影响预后。治疗前后IL-6差值平均数为1 551.31,P=0.003;说明治疗降低了IL-6水平。结论局限性CD手术治疗效果好,但仍有少数复发,并且复发后容易进展为多中心性CD,具有恶性倾向。值得进一步加强对CD诊断治疗的研究。

OBJECTIVE Castleman disease（CD） is an undiagnosed reactive lymphadenopathy,which is reported less frequently and easily misdiagnosed during clinical diagnosis and treatment. This study reported clinical characteristics and surgical treatment of 19 Castlemans diseases,combined with related literature reviewe of CD. METHODS The clinical and follow-up data of 19 patients with local CD treated by Yunnan Provincial Tumor Hospital from August 2000 to August 2014 were analyzed,and its clinical features, pathological type, treatment methods and curative effect were summarized. The paired t test was used to compare the levels of IL-6 before and after treatment. RESULTS There were 19 cases of lo- cal Castleman patients in the group,including 8 males and 11 females. The ratio of males and females was 0.73 .＂ 1. Age from 16 years old to 41 years old,average age was 24.8 years old. All the initial symptoms were painless neck lumps with- out systemic symptoms. Lump in the neck V area in Ⅱ cases,the neck area （ Ⅱ --Ⅳ） in 8 cases, Ⅱ and Ⅲ area in 1 case, HI and iV area in 1 case,2 cases in Ⅱ, Ⅲ and Ⅳ area. Average size was 3.5cm （2.5 cm-8.5 cm）. All the patients under- went tumor resection,17 cases were complete resection, 2 cases were excised, and the pathological section were hyaline- vascular type. Follow-up duration was 1-129 months. Median follow-up time was 25 months. All the patients are surviv- al. Four patients had tumor recurrence and were survival with tumor. Prognosis was affected by the age of the patient, tumor size and levels of interleukin 6 in blood. The mean value of IL-6 was 1 551.31 after treatment, the value of P was 0. 003 that was less than 0.05. The difference was statistically significant,indicating that the treatment decreased IL-6 lev- el. CONCLUSIONS The surgical treatment of local Castleman disease has good effects even for patients with recurrence. The study on diagnosis and treatment of Castleman disease is worthy to be further strengthened.