| Objective: To study the clinical characteristics, diagnosis and the feasibility of surgical treatment for primary intestinal non-Hodgkin lymphoma(PINHL), in order to provide the reference for the future of the diagnosis and treatment of PINHL.Methods: 21 cases of primary intestinal non-Hodgkin lymphoma pathologically confirmed clinical data were analyzed.Results:1.The general condition of PINHL patients: In 21 cases of PINHL patients, male to female ratio was 2.5:1(15:6), and the mean age was 53±15, median of duration for these patients is two months.2.The clinical manifestation: In 21 cases of PINHL patients, the patients number with abdominal pain is 17 cases(80.95%), changing for shape \ characters of stool is 12cases(57.14%), weight loss in 8 cases(38.09%),6 patients can be touched with goiter in abdominal part(28.57%), 5 cases got fever(23.81%);There were 10 patients came to hospital for the complications of PINHL,including acute intestinal obstruction 8 cases(38.09%), hemorrhage of digestive tract 1 case, and intussusception 1 case;3.Auxiliary examination: blood examination: in 21 cases of PINHL, red blood cell(RBC) decreased in 9 cases(42.86%), hemoglobin(HGB) decreased in 11cases(52.38%), total protein(TP) decreased in 14 cases(66.67%), albumin(ALB) decreased in 13 patients(61.90%), prealbumin(PA) decreased in 13cases(61.90%), D-DIMER increased in 10 cases(47.62%), 6 cases with elevated lactate-dehydrogenase(LDH)(28.57%), and the conventional tumor markers had no obvious abnormalities; Enhanced CT indicated that all of the cases shows occupying changes, of which 14 cases(66.67%) reported as colon cancer;4.Pathology, immunohistochemistry and the Ann Arbor stage: In this group,the postoperative pathology indicated that the number of diffuse large B cell lymphoma is16(76.19%),and there were 3 cases of T cell lymphoma(14.29%) and 1 cases of mantle cell lymphoma.Immunohistochemical classification point out that in this group,18 cases is B cell source(85.71%), 3 cases is T cell source(14.29%).According to Ann Arbor stage, there were 13 cases(61.90%) in stage I E,5 patients in stageⅡE(23.81%); 2 cases in stage ⅢE,only 1 patient in stage IV E.5.Comprehensive surgical treatment: All patients in this group underwent surgical operation treatment, of which 7 cases(33.33%) performed small intestinal tumor resection, 6 cases(28.57%) performed radical left colon resection,6 cases(28.57%)performed radical resection of right colon, and one performed palliative resection of the right half colon, one performed intestinal anastomosis plus colostomy. After surgery operation, all patients were suggested to have a further chemotherapy in 1-2weeks, including 10 cases of R-CHOP solution(47.62%), 9 cases of CHOP solution(42.85%), 1cases of CVP solution,only one case of DICE solution(patient refused to use rituximab monoclonal antibody);Conclusion: For most patients with PINHL,we should particularly pay attention to:①Necessary surgical operation indication and selected operation: necessary surgical operations always apply to some complications caused by primary disease diagnosis;apply to patients which hard to diagnosis or difficult to obtain pathologic;and applied to the assessment process that cannot to lerate chemotherapy; radical operation, such as colorectal cancer radical operation should been done with reference to the same lesion malignant tumors;②At present, the treatment of PINHL model for the pathological diagnosed patients is a kind of comprehensive treatment,operation always not as a main method;In view of the complexity of the diagnosis and treatment, the surgeon should be timely grasp the present progress state of PGIL,and the treatment should be based on multidisciplinary cooperation mode, strictly abide by the international guidelines and related principles of treatment, blindly surgical intervention can not regard as the preferred method of conventional PGIL. In clinical treatment, we should flexible grasp the indication of surgical care; and only in this way we can not to bring the patient unnecessary operational trauma. |
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