61例原发性胃肠道恶性淋巴瘤的诊断和治疗

Diagnosis and Treatment of 61 Cases of Primary Gastrointestinal Malignant Lymphoma

目的探讨原发性胃肠道恶性淋巴瘤(PGIL)的临床特点,以提高该病的诊治水平。方法回顾性分析该院2009年1月—2018年12月收治的61例PGIL患者的临床资料。结果61例PGIL患者中,男36例,女25例,年龄23~91岁,中位年龄63.3岁。原发病灶位于胃28例,肠道33例。患者的主要症状为上腹痛者45例(73.8%),呕血、黑便6例(9.8%),纳差、乏力4例(6.6%),腹部包块5例(8.2%)。该组29例(47.5%)行内镜检查,43例(70.5%)行腹部CT检查。该组未行手术者22例(36.1%),行手术治疗者39例(63.9%),其中行根治性肿瘤切除术36例。免疫组化类型主要是B细胞淋巴瘤55例(90.2%),包括弥漫性大B细胞淋巴瘤(DLBCL)42例(68.9%),胃黏膜相关性淋巴瘤(MALT)10例(16.4%)和T细胞淋巴瘤4例(6.5%)。Musshoff肿瘤分期:Ⅰ期19例(31.1%),Ⅱ期23例(37.7%),Ⅲ期11例(18.0%),Ⅳ期8例(13.1%)。该组随访时间4~108个月,中位随访时间62.5个月,1、3、5年生存率分别为93.4%、83.6%、72.1%。结论①PGIL临床表现多样,腹痛是最常见的症状。DLBCL是最常见的病理类型。②PGIL术前确诊率低,内镜及病理活检是术前确诊的主要方法;③PGIL手术和(或)化疗均安全、有效,可根据患者情况个体化选择应用。

Objective To investigate the clinical characteristics of primary gastrointestinal malignant lymphoma(PGIL)in order to improve the diagnosis and treatment of this disease.Methods The clinical data of 61 PGIL patients admitted to the hospital from January 2009 to December 2018 were retrospectively analyzed.Results Among 61 PGIL patients,36 were males and 25 were females,aged 23-91 years old,median age 63.3 years old.The primary lesion was located in 28 cases in the stomach and 33 cases in the intestine.The main symptoms of the patients were upper abdominal pain in 45 cases(73.8%),hematemesis and melena in 6 cases(9.8%),anorexia and fatigue in 4 cases(6.6%),and abdominal mass in 5 cases(8.2%).In this group,29 cases(47.5%)underwent endoscopy,and 43 cases(70.5%)underwent abdominal CT examination.22 cases(36.1%)did not undergo surgery,39 cases(63.9%)received surgical treatment,of which 36 cases underwent radical tumor resection.The main types of immunohistochemistry were 55 cases(90.2%)of B-cell lymphoma,including 42 cases(68.9%)of diffuse large B-cell lymphoma(DLBCL)and 10 cases(16.4%)of gastric mucosa-associated lymphoma(MALT)and 4 cases(6.5%)of T-cell lymphoma.Musshoff tumor staging:19 cases(31.1%)in stage Ⅰ,23 cases in stage Ⅱ(37.7%),11 cases in stage Ⅲ(18.0%),and 8 cases in stage Ⅳ(13.1%).Patients in this group were followed up for 4 to 108 months months,median follow-up time 62.5 months.The 1,3,and 5-year survival rates were 93.4%,83.6%,and 72.1%,respectively.Conclusion 1.The clinical manifestations of PGIL are diverse,and abdominal pain is the most common symptom.DLBCL is the most common type of pathology.2.The preoperative diagnosis rate of PGIL is low.Endoscopy and pathological biopsy are the main methods of preoperative diagnosis;3.PGIL surgery and/or chemotherapy are safe and effective,and can be selected and applied individually according to the patient's condition.