摘要目的 探讨原发性胃淋巴瘤(PGL)的临床、内镜、病理特点和影响预后的相关因素,以提高PGL的诊治水平.方法 回顾性分析2001年1月至2010年12月经手术和内镜活组织检查证实的63例PGL患者的临床表现、内镜下表现和病理特点.采用Kaplan-Meier法进行生存分析,Cox比例风险模型多因素分析疾病预后.结果 63例PGL患者中,男40例,女23例,平均年龄为(59.8±13.3)岁.腹痛、腹胀、消化道出血为主要的临床表现者分别占47.6％(30/63)、17.5％(11/63)、17.5％(11/63).39例(61.9％)PGL患者内镜下表现为溃疡,34例(54.0％)累及胃窦.最常见的病理类型为弥漫大B细胞淋巴瘤(DLBCL),共45例(71.4％),其次为MALT淋巴瘤14例(22.2％).DLBCL患者H.pylori阳性率低于MALT淋巴瘤患者[37.8％(17/45)比10/14],差异有统计学意义(x2=4.872,P=0.027).PGL患者1、3、5年累积生存率分别为74.6％、63.5％、55.6％,平均生存时间(95％CI)为(41.5±3.0)月(35.7～47.4月).DLBCL患者中,单纯手术治疗组、单纯化学治疗组和联合治疗(手术治疗+化学治疗)组平均生存时间分别为(50.17±8.98)、(41.39±4.40)、(38.33±5.21)月,3组间两两比较比较差异均无统计学意义(P均＞0.05).H.pylori阳性组DLBCL患者平均生存时间较H.pylori阴性组长[(51.90±4.30)月比(33.30±4.50)月],差异有统计学意义(t=-4.004,P＜0.01).结论 男性PGL略多于女性,腹痛是最常见症状.溃疡型病变是最常见的内镜下表现,胃窦最易受累.DLBCL是最常见的病理类型,手术联合化学治疗尚不能有效延长患者生存时间.

abstractsObjective To explore the clinical,endoscopic,pathologic and prognostic characteristics of primary gastric lymphoma (PGL) and to improve the level of diagnosis and treatment.Methods Sixtythree patients who were confirmed as PGL with operation and endoscopic biopsy pathology during January 2001 to December 2010 were retrospectively analyzed with respects of clinical,endoscopic and pathologic features.Survival analysis and prognosis were evaluated by kaplan-Meier and Cox proportional hazard model,respectively.Results In 63 PGL patients,the numbers of male and female were 40 and 23,respectively,and the average age was (59.8±13.3)years.The major symptoms were abdominal pain,abdominal distension,and gastrointestinal hemorrhage,accounting for 47.6 ％ (30/63),17.5 ％ (11/63),and 17.5 ％ (11/63),respectively.There were 39 (61.9 ％) PGL patients with endoscopic performance for ulcers,34 (54.0 ％) cases involved the gastric stomach antrum.The most immunohistochemistry analyses were diffuse large B-cell lymphoma (DLBCL) (71.4 ％,45/63),followed by mucosa-associated lymphoid tissue (MALT) lymphoma (22.2％,14/63).The frequency of Helicobacter pylori (H.pylori) positivity was lower in patients with DLBCL than that in patients with MALT lymphoma (37.8％(17/45) vs 10/14,x2 =4.872,P=0.027).The accumulate survival rates of one,three and five years were 74.6％,63.5％,55.6％,respectively,and the average survival time was (41.5±3.0) months (95％ confidence interval (CI) 35.7 to 47.4 months) in PGL patients.There was no difference in the average survival time between DLBCL patients treated with surgery combined chemotherapy and those with surgery or chemotherapy alone (38.33±5.21) months vs (50.17±8.98) months vs (41.39±4.40) months,P＞0.05).The patients diagnosed as DLBCL with H.pylori positive had longer average survival time than those with H.pylori negative ((51.90±4.30) months vs (33.30±4.50) months,t=-4.004,P＜0.01).Conclusions Male patients with PGL are slightly more than female.Abdominal pain is the most frequent symptom.Ulcerative lesions are the most common endoscopic demonstrations mostly at stomach sinus.DLBCL is the most pathologic characteristic.There is no significant difference in the survival rate between patients treated with surgery combined with chemotherapy and those treated with surgery or chemotherapy alone.