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目的探讨外科手术在儿童原发性胃肠道非霍奇金淋巴瘤(NHL)诊断、治疗中的作用。方法回顾性分析本院收治的9例儿童原发性胃肠道NHL的临床及随访资料,对儿童原发性胃肠道NHL的外科诊治及疗效进行临床总结分析。结果本组病例中男7例,女2例;年龄(5.59±3.27)岁。9例均经术后病理证实为胃肠道NHL,其中临床表现为腹部肿块7例,腹痛5例,发热3例,呕血黑便2例,便秘、阵发性腹痛伴呕吐各1例。诊断为肠套叠、急性阑尾炎、肠梗阻肠穿孔、十二指肠梗阻各1例,消化道出血2例,腹腔占位3例。1例行肠套叠复位术加肿瘤切除加末端回肠升结肠吻合术;1例行阑尾切除术;1例行肿瘤活检术加横结肠造瘘术;6例行剖腹探查术。病理检查示6例为Burkitt淋巴瘤,2例为弥散性大B细胞性淋巴瘤,1例为间变性大细胞性淋巴瘤,其中Ⅰ期、ⅠE期各1例,Ⅱ期2例,ⅡE期3例,Ⅲ期2例。9例均行手术治疗,1例术后死亡,8例术后均恢复良好,且经不同疗程化疗后1、3a生存率分别为75.0%及37.5%。结论儿童胃肠道NHL常以急腹症为首发症状,经外科手术、化疗等综合治疗可获得良好疗效。
Objective To investigate the role of surgery in the diagnosis and treatment of children with primary gastrointestinal non-Hodgkin’s lymphoma (NHL). Methods The clinical and follow-up data of 9 children with primary gastrointestinal NHL admitted to our hospital were retrospectively analyzed. The clinical diagnosis and treatment of primary gastrointestinal NHL in children were summarized. Results There were 7 males and 2 females in this group, with a mean age of (5.59 ± 3.27) years. All 9 cases were proved to be gastrointestinal NHL by pathology. The clinical manifestations were abdominal mass in 7 cases, abdominal pain in 5 cases, fever in 3 cases, hematemesis melena in 2 cases, constipation and paroxysmal abdominal pain with vomiting in 1 case. Diagnosis of intussusception, acute appendicitis, intestinal obstruction intestinal perforation, duodenal obstruction in 1 case, 2 cases of gastrointestinal bleeding, abdominal mass in 3 cases. 1 cases of intussusception combined with resection plus end ileal ascending colon anastomosis; 1 case of appendectomy; 1 case of tumor biopsy plus transverse colostomy; 6 cases of laparotomy. Pathological examination revealed 6 cases of Burkitt’s lymphoma, 2 cases of diffuse large B cell lymphoma, 1 case of anaplastic large cell lymphoma, of which Ⅰ, Ⅰ E in 1 case, Ⅱ in 2 cases, Ⅱ E 3 cases, Ⅲ period in 2 cases. Nine patients underwent surgical treatment. One patient died after operation and eight patients recovered well after operation. Survival rates at 1 and 3 months after chemotherapy were 75.0% and 37.5%, respectively. Conclusion Children with gastrointestinal NHL often take acute abdomen as the first symptom. After the comprehensive treatment with surgery and chemotherapy, good curative effect can be obtained.