本文選題：輸尿管 + 淋巴瘤��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的提高對原發(fā)性結(jié)外霍奇金淋巴瘤的認識，提高該疾病的治愈率及生活質(zhì)量。 方法前瞻性分析在山西大醫(yī)院淋巴腫瘤科確診的原發(fā)性輸尿管霍奇金淋巴瘤一例。本例患者為男性，64歲，，主因“尿頻、排尿不盡、尿等待3個月，加重1周”住院。住院后于泌尿外科行超聲及CT（Computed tomography,計算機斷層掃描）檢查顯示：右側(cè)腎盂及輸尿管上段積水?dāng)U張，右側(cè)輸尿管下段管壁增厚、管腔狹窄，腹主動脈周圍多發(fā)腫大淋巴結(jié)，考慮輸尿管癌并淋巴結(jié)轉(zhuǎn)移可能。此例患者行手術(shù)治療，右側(cè)輸尿管鏡檢術(shù)中轉(zhuǎn)右側(cè)輸尿管探查術(shù)，術(shù)中分離下段輸尿管大約10cm，可見輸尿管周圍結(jié)節(jié)狀增生組織，質(zhì)地較硬；縱向切開輸尿管約3cm，可見輸尿管壁增厚，未見明顯新生物，橫向切取1cm輸尿管送病檢。雙J管置入，常規(guī)留置潘氏引流管，結(jié)束手術(shù)。術(shù)后病理報告：輸尿管壁增厚，粘膜層及漿膜層可見多量嗜酸性粒細胞、中性粒細胞、小淋巴細胞及漿細胞，另見體積較大細胞散在分布，胞質(zhì)豐富，核大，單核為主，核型不規(guī)則，染色質(zhì)粗，核仁明顯，略嗜酸。免疫組化結(jié)果：CD30（+）、CD68部分細胞（+）、LCA部分弱（+）、Ki67約10%（+）、CD15（—）、PAX5（—）。該例患者病理診斷為原發(fā)性輸尿管霍奇金淋巴瘤,混合細胞型。予ABVD（pirarubicin bleomycin vincristine dacarbazine,吡柔比星博來霉素長春新堿達卡巴嗪）方案行八周期的化療。 結(jié)果患者經(jīng)八周期ABVD方案化療后，尿頻、排尿不盡、尿等待癥狀消失。全身PET-CT(Position emission tomography-Computed tomography,正電子發(fā)射—計算機體層顯像)檢查：全身掃描未見高代謝影。評估疾病達完全緩解，臨床治愈。已隨訪6個月，目前患者生活質(zhì)量良好，食欲好，體重增加15kg，無病生存。 結(jié)論原發(fā)性輸尿管霍奇金淋巴瘤臨床上十分罕見。中老年人多發(fā)。男性發(fā)病率高于女性，臨床表現(xiàn)無特異性，容易誤診為輸尿管癌和肉瘤。病灶組織手術(shù)活檢可明確病理診斷，治療不宜選擇輸尿管癌術(shù)式，經(jīng)化療可達治愈,而且保留腎臟，提高了生活質(zhì)量。影響該病的預(yù)后因素很多，與年齡、病程、組織類型、臨床分期和手術(shù)解除梗阻是否及時有關(guān)。
[Abstract]:Objective to improve the understanding of primary extranodular Hodgkin's lymphoma and improve the cure rate and quality of life.Methods A case of primary ureteral Hodgkin's lymphoma diagnosed by lymphatic oncology department of Shanxi Hospital was analyzed prospectively.This patient is 64 years old male, mainly because of frequent urination, inexhaustible urination, waiting for 3 months, aggravated 1 week hospitalization.Consider the possibility of ureteral carcinoma with lymph node metastasis.This patient underwent surgical treatment and the right ureteroscopy turned to right ureter exploration during the operation. The lower ureter was separated from the lower ureter about 10 cm during the operation. The nodular hyperplasia tissue around the ureter was visible and the texture was hard.Longitudinal incision of ureter about 3 cm, ureteral wall thickening, no obvious new organisms, transverse resection of 1cm ureter for examination.Double J tube was inserted, and Pen's drainage tube was routinely placed, and the operation was ended.The pathological report showed that the ureteral wall was thickened, and many eosinophils, neutrophils, small lymphocytes and plasma cells were found in the mucosal and serous layers, and the larger cells were scattered, the cytoplasm was abundant, the nucleus was large, and the mononuclear cells were dominant.The karyotype is irregular, chromatin is thick, nucleolus is obvious, slightly acidophilic.Immunohistochemical results showed that some of the CD68 cells were weak (about 10%).This patient was pathologically diagnosed as primary ureteral Hodgkin's lymphoma, mixed cell type.ABVD(pirarubicin bleomycin vincristine dacarbazine, imarubicin vincristine and dacarbazine were given eight cycles of chemotherapy.Results after eight cycles of ABVD regimen, the patients had frequent urination, inexhaustible urination and disappeared urine waiting symptoms.PET-CT(Position emission tomography-Computed tomography (positron emission-computer tomography): no hypermetabolic imaging was found.To evaluate the complete remission and clinical cure of the disease.The patients had been followed up for 6 months and had good quality of life, good appetite, weight gain of 15 kg and disease-free survival.Conclusion Primary ureteral Hodgkin's lymphoma is rare clinically.The middle and old people are more common.The incidence of ureteral carcinoma and sarcoma in males is higher than that in females.The pathological diagnosis could be confirmed by surgical biopsy of the lesion, and the operation method of ureteral carcinoma should not be chosen in the treatment, and the kidney could be cured by chemotherapy, and the quality of life was improved.There are many prognostic factors related to age, course of disease, tissue type, clinical stage and surgical relief of obstruction.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.13

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