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目的探讨原发性胃肠道非霍奇金淋巴瘤(PGINHL)的临床特征及治疗策略。方法收集内镜活检或手术病理组织学证实的PGINHL36例临床资料,回顾性分析其临床特点以及影响生存期的因素。结果PGINHL发生于胃部者占61.11%(23/38),粘膜表面呈肿块结节是PGINHL最常见内镜表现,占62.5%(20/32),ⅠE~ⅡE期占67.13%(26/36),B细胞淋巴瘤28例,占89.47%,其中MALT型结外边缘区B细胞淋巴瘤20例。本组采用手术及术后联合化疗,3~5年总生存率分别为84.4%和62.5%,其中ⅠE~ⅡE期患者3~5年总生存率分别为91.3%和70%,显著高于ⅢE~ⅣE期患者(P<0.01)。B细胞淋巴瘤3~5年总生存率分别为96%和66.7%,显著高于T细胞淋巴瘤(P<0.05)。其中HP(幽门螺杆菌)根除治疗MALT型结外边缘区B细胞淋巴瘤8例5年全部存活。结论PGINHL临床表现无特异性,容易误诊,胃部发生率最高,临床分期以ⅠE~ⅡE为主,病理分型以B细胞性为主,其临床分期和组织病理学类型是影响疗效和预后的重要因素,HP根除治疗有助于胃MALT淋巴瘤临床缓解。
Objective To investigate the clinical features and treatment strategies of primary gastrointestinal non-Hodgkin’s lymphoma (PGINHL). Methods The clinical data of 36 cases of PGINHL confirmed by endoscopic biopsy and histopathology were collected and retrospectively analyzed for the clinical features and the factors influencing survival. Results The incidence of PGINHL in the stomach was 61.11% (23/38). The nodules on the mucosal surface were the most common endoscopic findings of PGINHL, accounting for 62.5% (20/32) and 67.1% (Ⅰ / ⅡE) ), B-cell lymphoma in 28 cases, accounting for 89.47%, of which 20 cases of MALT-type extranodal marginal zone B-cell lymphoma. This group of surgical and postoperative combined chemotherapy, 3 to 5-year overall survival rates were 84.4% and 62.5%, respectively, which Ⅰ E ~ Ⅱ E 3 to 5-year overall survival rates were 91.3% and 70%, significantly higher than Ⅲ E ~ Ⅳ E patients (P <0.01). The overall 3-year 5-year survival rates of B-cell lymphoma were 96% and 66.7%, respectively, which were significantly higher than those of T-cell lymphoma (P <0.05). Which HP (Helicobacter pylori) eradication of MALT-type extranodal marginal zone B-cell lymphoma in 5 cases all survived 5 years. Conclusion The clinical manifestations of PGINHL are nonspecific, easily misdiagnosed and the highest incidence of stomach. The clinical stage is mainly ⅠE ~ ⅡE. The pathological type is mainly B cell. The clinical staging and histopathological types of PGINHL are influencing the curative effect and prognosis Important factor, HP eradication therapy contribute to the clinical remission of gastric MALT lymphoma.