摘要：
Objective To investigate the causes of misdiagnosis and preventive measures for primary small intestine lymphoma ( PSIL) . Methods The data of 14 misdiagnosed cases of PSIL who received treatment in De-partment of General Surgery, the 455 Hospital of PLA and Changhai Hospital from June 2004 to June 2016 were ana-lyzed retrospectively. Results Patients in this group accounted for 18. 4% (14/76) of all the patients admitted to the two hospitals during the same period. Abdominal pain was found in 14 cases, intestinal obstruction in 5 cases, gastrointestinal bleeding in 4 cases, palpable abdominal mass in 3 cases, and acute diffuse peritonitis in 2 cases. The number of patients who underwent abdominal color Doppler ultrasound, abdominal CT examination,digestive endosco-py and positron emission computed tomography was 14, 12, 5 and 1, respectively. However, all were not diagnosed clearly. The numbe of patients who were misdiagnosed as Crohn disease, intestinal tuberculosis, small bowel cancer, small intestinal stromal tumor and cecal cncer was 5, 4, 3,1 and 1, respectively. Surgical treatment was performed in 14 cases, radical resection in 10 and palliative operation in 4. Postoperative pathological examination confirmed PSIL, including 13 cases of non-Hodgkin's lymphoma ( 10 cases of B-cell and 3 cases of T-cell) and 1 case of Hodgkin lymphoma. After 1-10 years of follow-up, 5 cases were lost to follow-up and only 1 survived. Conclusion The clinical and imaging findings of PSIL are not specific. PSIL should be suspected in terms of small intestinal mass in the early stage of abdominal CT, with acute intestinal obstruction, acute diffuse peritonitis and gastrointestinal bleeding, which can be confirmed by means of pathological examinations.%目的 探讨原发性小肠淋巴瘤( primary small intestine lymphoma, PSIL)误诊原因及防范措施.方法 对2004年6月—2016年6月解放军455医院和海军军医大学长海医院普通外科收治的14例PSIL误诊病例资料进行回顾性分析.结果 本组占两院同期收治患者的18. 4% (14/76). 14例有腹痛,5例伴有肠梗阻,4例伴有消化道出血,3例可触及腹部包块,2 例伴有急性弥漫性腹膜炎. 14 例行腹部彩超,12 例行腹部CT检查,5例行消化内镜检查,1例行正电子发射型计算机断层扫描,均未明确诊断,术前误诊为Crohn病5例,肠结核4例,小肠癌3例,小肠间质瘤、盲肠癌各1例. 14例均行手术治疗,10例行根治性切除术,4例行姑息性手术.术后病理检查均确诊为PSIL,其中非霍奇金淋巴瘤13例( B细胞型10例、T细胞型3例) ,霍奇金淋巴瘤1例.随访1～10年,失访5例,仅存活1例.结论 PSIL临床和影像学表现均无特异性,对于腹部CT检查早期发现小肠肿块并伴急性肠梗阻、急性弥漫性腹膜炎及消化道出血者要警惕本病可能,确诊有赖于病理检查.
