胃肠道原发性恶性淋巴瘤的诊断与治疗

Diagnosis and Treatment of Primary Malignant Lymphoma of Gastrointestinal Tract

目的 探讨胃肠道原发性恶性淋巴瘤的诊断与治疗。方法 回顾性分析了 46例胃肠道原发性恶性淋巴溜患者的临床资料。结果 46例原发性恶性淋巴瘤中Ⅰ、Ⅱ、Ⅲ和Ⅳ期分别为 16例、 18例、 9例和 3例。术前内镜活检确诊 12例 ,3 4例经手术与病理确诊。 43例行手术切除 ,另 3例Ⅳ期行单纯活检。术后辅助化疗 3 2例 ,放疗 +化疗 12例。 1年生存率Ⅰ～Ⅲ期为 10 0 % ,Ⅳ期 66 7% ;3年及 5年总生存率分别为72 5 %及 61 6%。结论 本病早期不易诊断 ,内镜活检及手术病理检查是确诊本病的主要方法。对Ⅰ、Ⅱ、Ⅲ期病例根治性手术切除应作为首选治疗 ,术后辅助化 (放 )疗可提高生存率。对Ⅳ期应以全身化疗 +局部放疗为主要治疗手段。

Objective To explore the diagnosis and treatment of primary malignant lymphoma of gastrointestinal tract (PMLGI). Methods The clinical data of 46 PMLGI cases was analyzed retrospectively. Results Among 46 cases, the Ⅰ,Ⅱ,Ⅲ and Ⅳ phases of PMLGI accounts for 16, 18, 9 and 3 cases respectively. Twelve cases got final diagnosis by endoscopy biopsy and thirty-four cases by operation and pathology. Forty-three cases were removed by operation, while biopsy only in the other 3 cases of Ⅳ phases. Postoperative adjuvant chemotherapy and radiotherapy plus chemotherapy were applied for 32 and 12 cases respectively. The 1～year survival rate for Ⅰ～Ⅲ and Ⅳ phases was 100% and 66 7%, respectively, while the 3～year and 5～year survival rate for all cases was 72 5% and 61 6%, respectively. Conclusions Early diagnosis is difficult for PMLGI, which diagnose definitely by endoscopy biopsy and operative pathology mainly. Radical resection is the primary method for Ⅰ～Ⅲ phases and postoperative adjuvant chemotherapy and radiotherapy are helpful to raise the survival rate. Systemic chemotherapy plus local radiotherapy is the main therapy for Ⅳ phases.