外科治疗原发性恶性胃肠道淋巴瘤39例临床研究

摘要

Objective To evaluate the efficacy of surgery for treating primary gastrointestinal lymphoma ( PGIL) , thus to provide clinical evidences for deciding surgical timing and approaches .Methods Clinical data of 39 PGIL pa-tients receiving abdominal surgeries in Sun Yat -sen University Cancer Center between October 1990 and March 2014 were retrospectively analyzed.Among these patients, 32 cases were male, with median age of 47 (range 18 from 76).Lo-gistic step-wise analysis was adopted to screen out risk factors for PGIL -related complications , while the survival rates were compared among patients performed different surgical procedures by using Kaplan -Meier method.Results Selec-tive operations were performed in 28 case (71.8%), while 11 cases (28.2%) received emergency operation due to acute abdomen.In total patients, 23 cases (59.0%) had tumor radical resection, 11 cases (28.2%) had partial tumor resec-tion and the rest 5 cases failed to tumor resection .Except for 3 cases ( 7.7%) with surgical operation alone , 36 cases were given with comprehensive treatment , including 23 cases (59.0%) with surgery and postoperative chemotherapy , 13 cases (33.3%) with preoperative chemotherapy and surgery .Logistic analysis indicated that preoperative chemotherapy was the independent risk factor accounting for complications on PGIL ( OR =5.083, 95%CI 1.028 ~25.135, P =0.046).In survival analysis, 2-year and 5-year overall survival rates were both 82.3%in selective operation patients, which were significantly higher than 34.1%and 17.0%, respectively, in emergency operation patients (P=0.001).Pa-tients with tumor completely resection also showed a significantly better overall 5-year survival rate than that of tumor par-tial resection and non -resection (89.7%, 36.4% and 26.7%, P=0.006).Conclusion Preoperative chemotherapy is a crucial risk factor for PGIL-related complications , while surgical timing and excision extension are closely associated with patients′prognosis.Therefore, we suggest selective surgery should be performed with tumor radical resection for trea-ting PGIL to the greatest extent , meanwhile complications should be alerted for the patients who administrated chemothera -py without tumor resection .%目的 探讨外科手术治疗对原发胃肠道恶性淋巴瘤(PGIL)的临床疗效,为手术时机和手术方式的选择提供依据.方法 回顾性分析接受腹部外科手术治疗的39例PGIL患者的临床资料.其中,男32例,女7例,年龄18~75岁(中位年龄47岁).Ⅰ期12例(30.8%),Ⅱ期7例(17.9%),Ⅲ期6例(15.4%),Ⅳ期14例(35.9%).采用logistic逐步分析方法分析PGIL并发症的危险因素,应用Kaplan-Meier法比较不同手术方式的生存率.结果 28例行择期手术(71.8%),11例因急腹症行急诊手术(28.2%).其中,23例(59.0%)肿瘤完全切除,11例(28.2%)肿瘤部分切除,5例(12.8%)肿瘤未能切除.除3例(7.7%)患者单纯外科手术治疗外,36例均接受综合治疗,其中,23例(59.0%)行手术联合术后化疗,13例(33.3%)行新辅助化疗联合手术治疗.二元logistic逐步回归分析显示术前化疗是恶性胃肠道淋巴瘤发生急腹症的危险因素(OR=5.083,95%CI 1.028~25.135,P=0.046).生存分析提示,择期手术的2、5年生存率均为82.3%,明显高于急诊手术的34.1%、17.0%(P=0.001);肿瘤完全切除患者的5年生存率比部分切除及未切除患者显著提高(89.7%、36.4%和26.7%,P=0.006).结论 术前化疗是引起PGIL发生急腹症的重要危险因素,而手术时机和切除范围与患者预后密切相关.因此,PGIL应推荐择期手术,争取肿瘤的完全切除,对于肿瘤未切除而行化疗的患者应警惕急腹症的发生.