原发性胃肠道淋巴瘤的诊断与治疗

目的探讨原发性胃肠道淋巴瘤的临床特点及诊治方法。方法1983年至2004年在北京大学第一医院外科接受治疗的原发性胃肠道淋巴瘤患者35例,对其临床病理资料及预后进行回顾性分析。结果本组原发性胃肠道淋巴瘤术前诊断率仅为20.0%;18例胃淋巴瘤中16例接受手术治疗,其中12例行根治性切除;17例肠道淋巴瘤均手术治疗,其中14例行根治性切除;Ann Ar-bor临床分期为:ⅠE期14例,ⅡE期10例,ⅢE期1例,ⅣE期10例。MALT淋巴瘤与非MALT淋巴瘤在年龄、性别及发病部位及早晚分期上差异无显著性。MALT淋巴瘤组手术根治率(92.9%)高于非MALT淋巴瘤(68.4%),MALT淋巴瘤组淋巴结转移率(42.9%)明显低于非MALT淋巴瘤组(84.2%)。结论胃肠道淋巴瘤临床表现缺乏特异性,术前诊断率低;胃淋巴瘤与肠淋巴瘤在性别、年龄、手术根治性及临床分期方面无明显区别;MALT淋巴瘤组确诊时分期较早,手术根治率高,淋巴结转移率低,预后优于非MALT淋巴瘤组。外科手术是诊断和治疗原发性胃肠道淋巴瘤的主要方法。

Diagnosis and treatment of primary gastrointestinal lymphoma

Objective To explore clinic features and diagnostic and therapeutic methods of primary gastrointestinal lymphoma.Method A retrospective analysis was performed concerning the clinicopathologic data and prognosis of 35 patients with gastrointestinal lymphomas treated at surgical department of Beijing University First Hospital between 1983 and 2004.Results The diagnostic rate prior to operation was low,only 20.0%.Of 18 cases of gastric lymphomas,16 underwent surgical treatment,including radical surgery in 12 cases.The surgical treatment was performed for all 17 cases of intestinal lymphomas,including radical surgery in 14 cases.Comparing MALT lymphoma group with non-MALT lymphoma group,there were no statistically significant differences in age,sex,lesion location and Ann Arbor clinical stage.The rate of radical operation was higher in MALT lymphoma group than in non-MALT lymphoma group.The rate of lymph node metastasis was obviously lower in MALT lymphoma group(42.9%) than in non-MALT lymphoma group(84.2%).Conclusions Clinical manifestation of gastrointestinal lymphoma lacks specificity.Diagnostic rate prior to operation is low.There is no obvious difference in the sex,age,radical surgical cure and clinical stage between gastric lymphoma and intestinal lymphoma.The rate of radical operation is high,the rate of lymph node metastasis is low,and prognosis is better in MALT lymphoma group than in non-MALT lymphoma group.The surgical treatment is still the main method for diagnosis and treatment of primary gastrointestinal lymphoma.