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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。
Objective To investigate the clinical effect of surgical treatment on primary gastrointestinal malignant lymphoma (PGIL) and to provide evidence for the selection of operation timing and operation mode. Methods The clinical data of 39 PGIL patients undergoing abdominal surgery were retrospectively analyzed. Among them, 32 males and 7 females, aged 18 to 75 years (median age 47 years). 12 cases (30.8%) in stage Ⅰ, 7 cases (17.9%) in stage Ⅱ, 6 cases (15.4%) in stage Ⅲ and 14 cases (35.9%) in stage Ⅳ. Logistic stepwise analysis was used to analyze the risk factors of PGIL complications. The Kaplan-Meier method was used to compare the survival rates of different surgical methods. Results Twenty-eight patients underwent elective surgery (71.8%) and 11 patients underwent emergency surgery (28.2%) due to acute abdomen. Among them, 23 (59.0%) tumors were completely resected, 11 (28.2%) tumors were partially resected, and 5 (12.8%) tumors were not resected. Thirty-six patients underwent surgery combined with postoperative chemotherapy, while 13 patients (33.3%) underwent neoadjuvant chemotherapy combined with surgery, except for 3 patients (7.7%). Binary logistic stepwise regression analysis showed that preoperative chemotherapy was a risk factor for acute abdomen in patients with malignant gastrointestinal lymphoma (OR = 5.083, 95% CI 1.028-25.135, P = 0.046). Survival analysis showed that the 2- and 5-year survival rates of elective surgery were 82.3%, significantly higher than 34.1% and 17.0% of emergency surgery (P = 0.001). The 5-year survival rate of patients with complete tumor resection was significantly lower than that of partial resection and non-resection Patients were significantly higher (89.7%, 36.4% and 26.7%, P = 0.006). Conclusion Preoperative chemotherapy is an important risk factor for acute abdomen induced by PGIL. The timing of surgery and the extent of resection are closely related to the prognosis of patients. Therefore, PGIL should be recommended elective surgery for complete removal of the tumor for patients with tumor resection and chemotherapy should be alert to the occurrence of acute abdomen.