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目的 探讨纵隔大B细胞淋巴瘤的临床表现、诊断治疗方法以及手术治疗的作用.方法 回顾分析北京协和医院1998年至2008年间19例资料完整的纵隔大B细胞淋巴瘤患者的临床资料,根据手术与否,分为手术组(10例)和非手术组(9例),使用Kaplan-Meier法生存分析,评估患者的生存期、生存率.结果 19例患者的总体平均生存期为44个月,3年生存率为54%;手术组与非手术组的平均生存期分别为44和42个月,3年生存率分别为55%和54%,两者差异均无统计学意义.手术组中5例术前有上腔静脉综合征,术后症状均得到缓解.非手术组9例患者中,3例有上腔静脉综合征,在1～3个周期化学治疗后逐渐缓解.结论 纵隔大B细胞淋巴瘤的手术切除率低,手术对生存期没有显著影响,但是可以在短期内缓解上腔静脉综合征症状,并且能够提供明确的病理诊断.

Objective To study clinical manifestations, diagnosis, treatment, as well as effect of surgical operation, of primary mediastinal large B-cell lymphoma (PMBCL).Methods Data of 19 patients of PMBCL with complete clinical and pathological records hospitalized at Peking Union Medical College Hospital during 1998 to 2008 were retrospectively reviewed and analyzed.Kaplan-Meier method was used to estimate their survival time and survival rate in comparison of efficacy in those with surgical operation to those without it.Results Overall three-year survival rate was 54% for all the 19 patients, 55% for those with surgical operation and 54% without it, respectively, with an average survival time of 44 months, 44 months for those with surgical operation and 42 months without it, respectively, but not reaching at statistical significance.Symptoms of superior vena cava syndrome in five cases at admission relieved immediately after surgical operation, but symptoms of superior vena cava syndrome in three of nine cases in non-surgical group relieved gradually one to three weeks after chemotherapy.Conclusions Surgical operation has no significant effect on survival in patients with PMBCL, but it can relieve syndrome of superior vena cava syndrome and provide accurate pathological diagnosis.