Analysis Of Diagnosis And Surgical Treatment Of46Cases Of Primary Gastrointestinal Lymphoma

Objectiv: To investigate the clinical characteristics, diagnosis, surgical treatmentmethods and prognosis recovery position of primary gastrointestinal lymphoma.Methods: Retrospectively analyze of46patients with primary gastrointestinallymphoma who get surgical treatment in the Second Affiliated Hospital of DalianMedical University from January1998to December2012with the clinical, pathologicaland follow-up data.Result: In this group of46cases,26cases were male patients,20cases werefemale patients,24cases of primary gastric lymphoma.4cases of primary intestinallymphoma,18cases of primary colorectal or rectal lymphoma.46cases of diffusenon-Hodgkin’s lymphoma, the majority of them were diffuse large B-cell tumor. Lowgrade malignant tumor in21cases, moderate malignant tumor in10cases, high-grademalignant tumor in15cases among the rest. Inspection results ofimmunohistochemistry show that36cases of diffuse large B-cell lymphoma,5cases ofplasma cell lymphoma,3cases of T-cell origin,2cases immunohistochemical stainingunlabeled. The gross type:29cases were ulcers type,10cases were elevated type,7cases were diffuse infiltrative type. The main clinical manifestations include upperabdominal pain, non-specific gastrointestinal symptoms(including abdominaldiscomfort, loss of appetite, anorexia, nausea and vomiting, hematemesis), fever,weight loss, abdominal mass etc. Clinical staging according to the Ann Arbor stagingcan be divided into Phase I(lesions confined to a single lymph node)11cases, PhaseIE(involving a single extranodal organs simultaneously)6cases, Phase II(lesionsinvasion diaphragmatic side of multiple lymph node)8cases, Phase IIE (involvedextranodal organs simultaneously)5cases, Phase III(diaphragmatic lymph nodes aboveand below the lesions that can be associated with the spleen and extranodal organinvolvement)14cases and Phase IV(more than one extranodal organs or associated withliver/bone marrow involvement)2cases. All patients underwent preoperative gastroscopy or enteroscope. In24patients with gastric lymphoma patients,22casespreoperative lesions were found. In these22cases,12cases misdiagnosed as gastriccancer,2cases misdiagnosed as huge gastric ulcer,2cases misdiagnosed as gastricstromal tumors,6patients diagnosed exactly.22cases of intestinal malignantlymphoma,22cases found lesions by preoperative examination,16cases misdiagnosedas colorectal cancer,2cases misdiagnosed as intestinal stromal tumors, only4casesdiagnosed accurately by colonoscopy.The whole group preoperative diagnosis was only21.74%. Misdiagnosed period from2to6(an average of3months)months. In24casesof gastric malignant lymphoma patients, the first symptom of20patients showed upperabdominal pain and discomfort,6cases combined hematemesis melena,8casesaccompanied by fever; in22cases of intestinal lymphoma patients, all as the firstsymptom of abdominal pain or discomfort,6cases accompanied by fever,10casesaccompanied by melena,4patients with intestinal obstruction,2cases found pelvicnodules,2patients suffer from intestinal perforation. All patients underwent surgicaltreatment,14cases gastric lymphoma line radical gastrectomy,6cases line totalgastrectomy and esophageal anastomosis,2cases combined organ resection (spleen,pancreas body and tail),2cases line palliative distal gastrectomy resection.2cases ofintestinal lymphoma patients line partial small bowel resection,2cases line ileocecalresection of the tumor,16cases line right colon resection,2cases line rectal cancerradical mastectomy(Miles surgery).36patients were put chemotherapy and10caseswith the treatment of traditional Chinese medicine.37patients in the postoperativefollow-up timely, follow-up time from6to70months.1year survival rate was81.08%,3year survival rate was62.16%,5year survival rate was45.95%, the survival ratedecline with the increase of years.Conclusion: Primary gastrointestinal malignant lymphoma incidence is relativelylow, more complex clinical manifestations, the symptoms are not obvious. Differentparts of lymphoma in gender, age of onset, radical surgery, clinical stage and the tissueof origin were no significant differences. Conventional tests such as abdominal X-ray,CT and endoscopy examination often have no obvious specific performance and Thepathological biopsy is an important method. Early diagnosis, proper treatment and payattention to prevent complications should be suggested. Surgical treatment is veryimportant and the surgical approach should be a reasonable choice. It is necessary toimprove the survival rates and to avoid the impact of postoperative quality of life. The clinical stage, tumor size and pathological type are the main factors affecting primarygastrointestinal lymphoma prognosis. No statistic difference by postoperativechemotherapy and Chinese medicine comprehensive treatment in this group, needs toexpand the sample and further argument.