原发性肠道淋巴瘤临床误诊分析

Analysis of Clinical Misdiagnosis of Primary Intestinal Lymphoma

目的 探讨原发性肠道淋巴瘤的诊治手段及误诊原因、防范措施。方法 回顾性分析入院诊断为急性阑尾炎或阑尾周围脓肿的原发性肠道淋巴瘤4例的临床资料。结果 本组2例以转移性右下腹疼痛急性起病来院,2例以阵发性下腹部疼痛为主要表现;4例感染性指标升高,1例癌胚抗原升高,1例糖类抗原125升高。4例腹部CT检查提示右下腹回盲部肠壁局部增厚;2例行腹部超声检查分别提示阑尾周围脓肿和阑尾炎不能排除;2例行肠镜检查,仅1例提示回肠末段病变。2例入院诊断为急性阑尾炎,2例入院诊断为阑尾周围脓肿?误诊时间5~10 d。本组均行手术治疗,皆经术后病理检查确诊为原发性肠道淋巴瘤,规律化学治疗2~6个疗程;随访2~8个月,2例死亡,2例仍在随访中。结论 原发性肠道淋巴瘤发病率较低,且缺乏特异性临床表现及检查手段,易误诊。临床医师应提高对该病认识,遇及类似本文患者时要警惕原发性肠道淋巴瘤,及时完善相关检查,并结合病史和医技检查结果等综合分析诊断,对于术后病理检查明确诊断该病患者应及时给予化学治疗或综合治疗。

Objective To investigate the diagnosis and treatment measures,causes of misdiagnosis and preventive measures of primary intestinal lymphoma(PIL).Methods The clinical data of 4 patients with PIL diagnosed as acute appendicitis or appendix abscess on admission were analyzed retrospectively.Results In this group,2 patients presented to hospital with acute onset of metastatic lower right abdominal pain,2 patients with paroxysmal lower abdominal pain as the main manifestation.Four cases had increased infectivity indices,1 case had increased carcinoembryonic antigen,and 1 case had increased carbohydrate antigen 125.Abdominal CT examination in 4 cases showed local ileocecal wall thickening in the right lower abdominal region.Abdominal ultrasonography in 2 cases showed that periappendiceal abscess and appendicitis were not excluded.Two cases underwent colonoscopy,and only 1 case showed lesions in the distal ileum.Acute appendicitis was diagnosed in 2 patients and periappendiceal abscess was diagnosed in 2 patients.Misdiagnosis lasted 5-10 d.All patients underwent surgical treatment and were diagnosed as PIL by postoperative pathological examination.Chemotherapy lasted for 2 to 6 courses regularly.Two patients died at 2-8 months after follow-up.Two cases are still being followed up.Conclusion The incidence of PIL is low,and it is more likely to be misdiagnosed due to the lack of specific clinical manifestations and examination means.Clinicians should improve their understanding of this disease,be alert to PIL when encountering patients similar to those in this paper,improve relevant examinations in time,and make comprehensive analysis and diagnosis based on medical history and medical technical examination results.For patients clearly diagnosed with this disease by postoperative pathological examination,timely chemotherapy or comprehensive treatment should be given.