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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。
Objective: To analyze the diagnosis and treatment of primary gastrointestinal lymphoma (PGIL) so as to improve its diagnosis and treatment. Methods: The clinical manifestations, endoscopic features, pathological features, HP infection, treatment regimens and prognosis of 81 patients with PGIL were analyzed retrospectively. Results: The age of patients with gastric lymphoma (52.84 ± 15.33) years, the age of patients with intestinal lymphoma (42.09 ± 15.28) years. Common symptoms: abdominal pain 76.5%, gastrointestinal bleeding 55.6%, anemia 54.3%, abdominal mass 25.9%, hypoproteinemia 40.7%, intestinal obstruction 11.1%, abdominal distension, vomiting, anorexia, acid reflux and other non-specific gastrointestinal symptoms 32.1%, body mass decreased significantly 33.3%, fever 8.6%, diarrhea 7.4%, digestive tract perforation 1.2%, constipation 1.2%, dysphagia 1.2%. Endoscopic showed mass type 67.7%, ulcer 27.7%, diffuse 4.6%. Clinical diagnosis rate and endoscopic biopsy pathological diagnosis rates were 30.9% and 73.8%. MALT lymphoma accounted for 61.7%. HP detection rate of 39.5%, the positive rate of 37.5%. 69 patients underwent surgery, including 3 cases of preoperative chemotherapy and 34 cases of postoperative chemotherapy. 12 cases of non-surgical treatment, including 6 cases of chemotherapy and HP radical eradication therapy, and the other 6 cases to give up treatment. There was no significant difference in the survival rates between the three methods of operation alone, operation plus chemotherapy, chemotherapy alone and HP eradication in stage Ⅰ ~ Ⅱ patients (P> 0.05). Survival rates in patients with stage Ⅲ-Ⅳ surgery were lower than those in the other two groups (P <0.05). The 1-year survival rate was 96.39%, the 3-year survival rate was 70.96%, and the 5-year survival rate was 55.87%. Conclusion: The clinical and microscopic features of PGIL are not specific, and the clinical misdiagnosis rate is high. It is recommended to biopsy multiple biopsies or to repeat multiple biopsies, and immunohistochemistry to improve the pathological diagnosis rate. Treatment of choice for chemotherapy and HP eradication therapy.