Primary Gastric Lymphoma: A Clinical Analysis of 43 Cases

原發性胃淋巴瘤：43病例臨床綜合分析

羅錦河(Gin-Ho Lo) ； 蔡養德(Yang-Te Tsai) ； 李壽東(Shou-Dong Lee) ； 黎國洪(Kwok-Hung Lai) ； 伍偉華(Wai-Wah Ng) ； 林懷正(Hwai-Jeng Lin) ； 譚振焜(Tseng-Nip Tam) ； 陳瑜珍(Yu-Jan Chan)

《中華民國消化系醫學會雜誌》 4卷3期 (1987/09) Pp. 128-134

https://doi.org/10.6557/GJTa.198709_4(3).0005

摘要

原發性胃淋巴瘤並不常見，臺北榮民總醫院自民國69年至74年，共有43病例經證實確為原發性胃淋巴瘤，我們根據病歷記載及追綜結果，作一回顧性分析，俾能有助於國人對此一疾病之了解。
病患平均年齡55歲，男女性別之比為2比1。主要症狀為上腹痛及體重減輕，與一般胃癌不易區分。病灶以胃體部及前庭最多。診斷方法以上胃腸道X光及內視鏡檢查為主，分別有79%及88%判定為惡性瘤。惟在本研究里，內視鏡病理切片能正確診斷為淋巴瘤者，僅有33%。肉眼外觀常見者，依次為潰瘍型，浸潤型及類息肉型，各佔64%，60%及25%。病理分類方面，以淋巴球性淋巴瘤最多，佔64%，組織球性淋巴瘤次之，佔22%，何杰金氏症則非常罕見，佔5%。原發性胃淋巴瘤之存活率與臨床分期關係密切，其二年存活率，I(下標 E)為83%，Ⅱ(下標 E)為 50%，Ⅲ(下標 E)及IV期均為0%。本研究發現組織球性淋巴瘤之五年存活率最高，為83%。所有胃淋巴瘤之五年存活率則為33%。治療方面以局部胃切除加上化學治療或放射線治療之二年存活率最高，各為89%及80%。
43例中，有4例存活超過十年，其共同特色為臨床分期都是Ⅱ(下標 E)以內，其中3例屬於組織球性淋巴瘤，其治療方法都是次全胃切除加上化學治療或放射線治療。因此，早期之診斷，加上適當之治療，原發性胃淋巴瘤之病患是極有可能治癒的。

關鍵字

胃腫瘤 ； 淋巴結外淋巴瘤 ； 原發性胃淋巴瘤

並列摘要

A retrospective study of 43 patients with primary gastric lymphoma, diagnosed and treated during the period between 1970-1985, was made to evaluate the influence of clinicopathologic features and relative effectiveness of the various modalities of diagnosis and treatment. The mean age at presentation was 55 years old. The male to female ratio was 2:1. The most Prominent presenting symptom was epigastralgia. The tumor mass was most frequently located at the gastric body and antrum. Preoperative gastric barium studies and endoscopy successfully identified malignancy in 79% and 88%, respectively. Endoscopic biopsy yielded 33% positive rates only. The gross pathology could be divided into three types: ulcerative 64%; infiltrative, 60% and polypoid 25%. In histologic classification, the lymphocytic type comprised 64%, histiocytic 22%, Hodgkin's disease 5%. The survival was closely correlated with staging. Two-year survival rates of I(subscript R)-IV stages were 83%, 50%, 0%, 0%, respectively. In this study, the most favorable histologic type was histiocytic type, the five-year survival rates of which were 83%. Subtotal gastrectomy combined with chemotherapy or radiotherapy gave the best outcome, their two year survival rates were 89% and 80%, respectively. Four cases survived more than ted years after diagnosis; their clinical data are summarized and analyzed.

並列關鍵字

gastric neoplasm ； extranodal lymphoma ； primary gastric lymphoma