【摘要】 目的:分析原发性胃肠道淋巴瘤(PGIL)的诊断与治疗现状,以期提高其诊治水平。方法:对81例PGIL的临床表现、内镜特征、病理特点、HP感染、治疗方案以及预后进行回顾性分析。结果:胃淋巴瘤患者年龄(52.84±15.33)岁,肠淋巴瘤患者年龄(42.09±15.28)岁。常见症状:腹痛76.5%,消化道出血55.6%,贫血54.3%,腹部包块25.9%,低蛋白血症40.7%,肠梗阻11.1%,腹胀、呕吐、纳差、反酸等非特异性消化道症状32.1%,体质量明显下降33.3%,发热8.6%,腹泻7.4%,消化道穿孔1.2%,便秘1.2%,吞咽困难1.2%。内镜下表现为肿块型67.7%,溃疡型27.7%,弥漫型4.6%。临床诊断率及内镜下活检病理确诊率分别为30.9%和73.8%。MALT淋巴瘤占61.7%。HP检测率39.5%,阳性率37.5%。69例接受手术治疗,其中3例术前化疗,34例术后化疗。12例非手术治疗,其中6例单纯化疗及HP根除治疗,另6例放弃治疗。单纯手术、手术加化疗、单纯化疗及HP根除治疗3种方法的存活率在Ⅰ～Ⅱ期患者无显著性差异(P>0.05)。Ⅲ～Ⅳ期患者中单纯手术组存活率低于其他两组(P<0.05)。1年生存率为96.39%,3年生存率为70.96%,5年生存率为55.87%。结论:PGIL的临床及镜下表现缺乏特异性,临床误诊率高,建议多部位活检或重复多次活检,并应用免疫组织化学方法提高病理诊断率。治疗首选化疗及HP根除治疗。更多还原

【Abstract】 Objective To analyze the status quo of the diagnosis and treatments of primary gastrointestinal lymphoma(PGIL) in order to improve it.Methods Eighty-one patients with PGIL were analyzed retrospectively including clinical manifestations,endoscopic features,pathological features,HP infection,treatment,and prognosis.Results The age of patients with gastric lymphoma was(52.84±15.33) years.The age of patients with intestinal lymphoma was(42.09±15.28) years.Common symptoms included abdominal pain(76.5%),gastrointestinal bleeding(55.6%),anemia(54.3%),abdominal mass(25.9%),hypoproteinemia(40.7%),bowel obstruction(11.1%),abdominal distension,vomiting,and other non-specific gastrointestinal symptoms(32.1%),weight loss(33.3%);fever(8.6%),diarrhea(7.4%),digestive tract perforation(1.2%),constipation(1.2%),and dysphagia(1.2%).Endoscopic appearances were as follows:tumor type(67.7%),ulcer type(27.7%),and diffuse type(4.6%).Clinical diagnosis rate and endoscopic biopsy confirmation rate were 30.9% and 73.8%.MALT lymphoma accounted for 61.7% of the patients.HP detection rate was 39.5% and positive rate was 37.5%.A total of 69 patients received surgeries:3 had preoperative chemotherapy,and 34 had postoperative chemotherapy.Twelve patients had non-surgical treatment,6 patients of whom had simple chemotherapy and HP eradication therapy,and the other 6 gave up during the treatment.There was no significant difference in the survival rate of StageⅠ～Ⅱ patients in the surgery alone group,surgery plus chemotherapy group,and chemotherapy and HP eradication therapy group(P>0.05).The survival rate of Stage III～IV patients in the surgery alone group was lower than that in the other 2 groups(P<0.05).The 5-year,3-year,and 1-year survival rate was 55.87%,70.96%,and 96.39%,respectively.Conclusion There are no specific clinical and endoscopic features in PGIL,so the misdiagnosis rate is high.Multi-site biopsy or repeated biopsies and immunohistochemical methods can be used to raise the pathological diagnosis rate.Chemotherapy and HP eradication are recommended.更多还原