原發性小腸淋巴瘤的診斷和外科治療

黃桂填　徐　波

【摘要】 目的 探討原發性小腸淋巴瘤（primary small intestine lymphoma，PSIL）的臨床表現、CT特點，提出臨床策略。方法 回顧性分析2003年1月至2007年7月收治的15例PSIL的患者臨床資料。結果 15例患者中男9例，女6例，平均51.6歲。PSIL常見的臨床表現為：腹痛、腹部腫物、腸梗阻、消化道出血及消瘦；血CEA、CA199均正常。術前15例均行CT檢查，CT 初診檢出腫瘤15例，定性診斷準確12例；15例中，11例行消化道鋇餐檢查，4例檢出病變，僅1例提示淋巴瘤可能。15例患者均行手術治療，無圍手術期死亡，術后病理結果為PSIL，術后1年生存率為85.7%。 結論 PSIL無特異性臨床癥狀，消化道鋇餐診斷率低，CT掃描具有一定的特征，結合臨床具有較高的診斷價值。早期診斷對改善PSIL的預后十分重要，積極手術切除和輔助化療可以獲得良好效果。

【關鍵詞】 淋巴瘤；小腸；診斷

Diagnosis and surgical treatment of primary small intestine lyphoma

HUANG Gui-tian,XU Bo.Emergency Department,Guangzhou City Ist Peoples Hospital,Guangdong 51000,China

【Abstract】 Objective To approach the diagnosis and treatment of primary lymphoma of the small intestine.Methods The clinical data of 15 patients with primary lymphoma of the small intestine from January 2003 to July 2007 were reviewed.Results Of the 15 cases,9 cases were male and 6 cases were female,the average age was 51.6 years.The commonest clinical manifestation were as follow:abdominal pain,abdominal lump,bowel obstruction,alimentary tract hemorrhage and athrepsy.CEA and CA199 values of blood serum were normal.All of these cases were under went CT scanning before operation.In 12 of 15 cases were final diagnosised by CT scanning.11 cases were subjected to Ba-meal examinations.Positive results were found in 4 cases，and only 1 case was considered to be PSIL.All of them received surgical operation.The postoperative pathology of all the patients were primary small intestine lymphoma.The 1year postoperative survival rate was 85.7%.Conclusion

PSIL had no specificity clinical manifestation.Barium study had hypo-diagnosis ratio,CT scan had specific diagnostic characteristics for PSIL.In combination with CT scan and clinical manifestation examinations are mutually beneficial in the diagnostic process.Most of the patients with primary lymphoma of the small intestine were in advanced stages when operated or diagnosed,so early diagnosis and comprehensive therapy were the key to ameliorate the patientsprognosis.

【Key words】 Lymphoma;Small intestine;Imaging diagnosis

原發性小腸淋巴瘤（primary small intestine lymphoma，PSIL）是較少見的消化道惡性腫瘤，起病隱匿，臨床表現缺乏特征性，易于誤診。現收集本院2003年1月至2007年7月收治的PSIL 15例，本文將結合其臨床表現特征和CT特點進行綜合分析、診斷并提出臨床對策。

1 資料與方法

1.1 一般資料 本組病例共15例，其中男9例，女6例，發病年齡18~73歲，平均51.6歲，40歲以上者11例，占73.3%。病程1周~1.5年。臨床表現包括腹痛、腹部腫物、腸梗阻、消化道出血及消瘦，血腫瘤指標（CEA、CA199）均正常。所有病例均符合Dawson標準［1］：①無病理性淺表淋巴結腫大；②胸片無縱隔淋巴結腫大；③末梢血中無幼稚細胞或異常細胞；④腫瘤主要位于小腸或經淋巴管侵犯附近的淋巴結；⑤肝、脾無侵犯（鄰近病變的直接擴散除外）。

1.2 CT檢查 本組15例全部行腹部CT檢查，主要表現為腸壁增厚、腸腔內腫塊和腸系膜淋巴結腫大，繼發表現則有腸套疊、腸梗阻和少量腹水。根據其主要的異常CT征象，本組15 例淋巴瘤可分為浸潤型和腫塊型。其中浸潤型10例，表現為腸壁廣泛環形增厚（圖1），增厚的腸壁厚度在1.0~3.3 cm間。病變處的腸腔見“動脈瘤樣”擴張7例，最大的擴張腸腔內徑為4.1 cm，3例腸腔變化不大，另1 例腸腔輕度狹窄伴不完全性腸梗阻。病變累及腸管總長度最短8.3 cm,最長達36 cm。腫塊型5例，表現為腸壁局限性或環形增厚，腸腔內或腸壁腫塊形成（圖2），腫塊直徑2.7~8.1 cm，其中2例腸腔擴張，1例腸腔狹窄伴不全梗阻。15例病變平掃均表現為軟組織密度，2例浸潤型和5例腫塊型病灶內可見不規則低密壞死區，增強掃描病灶輕度強化。7例病變段腸壁周圍脂肪間隙消失。9例合并腸系膜淋巴結腫大。CT診斷結果：浸潤型10例，9例定性正確，1例誤診腸腺癌；腫塊型5例，3例定性正確，1例未定性，1例誤診為間質瘤；CT初診檢出腫瘤15例，定性診斷準確12例。

1.3 消化道鋇餐檢查 本組11例術前行消化道鋇餐檢查，1例腸壁黏膜皺襞消失，腸腔擴張，提示淋巴瘤可能；1例腸壁黏膜皺襞消失，見多發細小龕影，誤診為局限性腸炎；2例提示外壓性改變，另7例未見明顯異常。

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