本文選題：原發(fā)性中樞神經系統(tǒng)淋巴瘤 + 診斷��； 參考：《吉林大學》2014年碩士論文

【摘要】：原發(fā)性中樞神經系統(tǒng)淋巴瘤（primary central nervous system lymphoma,PCNSL）是一種較罕見的中樞神經系統(tǒng)惡性腫瘤，目前臨床診斷尚有困難，治療效果不令人滿意，深入研究PCNSL的臨床特點、診斷要點及有效治療方法，具有重要臨床應有價值。 目的：分析PCNSL的臨床特征及治療效果，旨在提高臨床上對本病診斷和治療的認識，進一步改善診斷和治療現(xiàn)狀。 方法：收集吉林大學第一醫(yī)院神經腫瘤外科從2009年9月至2011年9月期間收治的PCNSL25例，對患者的年齡、性別、發(fā)病時間、影像學資料、手術治療資料、病理學資料、患者轉科后系統(tǒng)放化療資料以及患者預后等情況進行回顧性分析總結。 結果：本組25例病例中所有患者均無器官移植手術史、惡性腫瘤及自身免疫性疾病史，HIV抗體檢查均陰性，其中男17例，女8例，男：女=2.1:1；發(fā)病年齡12~73（平均52.4）歲，其中50歲者18例（72%），，18歲者2例，兩者占總患者人數(shù)80.0%。患者病程為6天~10個月，平均3個月。根據臨床表現(xiàn)和核磁共振成像等影像學檢查資料診斷為PCNSL。所有患者均行手術切除腫瘤（17例完全切除，8例部分切除）。組織病理學檢查診斷：21例為彌漫性大B細胞性淋巴瘤（占84%），3例為小B細胞性淋巴瘤（占12%），1例為T淋巴細胞淋巴瘤（占4%）。5例患者(20.0%)接受全腦放射治療，生存期為13~32個月，中位生存期為22個月；5例患者(20.0%)接受大劑量甲氨蝶呤化療，生存期為17~40個月，中位生存期為25個月；7例患者(28.0%)接受大劑量甲氨蝶呤聯(lián)合全腦放射治療，生存時間為21~48個月，中位生存期為30個月；8例患者(32.0%)因病情較重或經濟等原因手術后放棄放化療，生存期最短，只有3~7個月，中位生存期僅4.5個月。 結論： 1．本組25例PCNSL患者中男、女比例為2.1:1；發(fā)病平均年齡52.4歲，50歲以上患者18例（72%）；病程為6天~10個月。 2．核磁共振平掃加增強掃描是診斷PCNSL最有價值的檢查方法。 3．手術切除腫瘤后，僅接受全腦放射治療、單用大劑量甲氨蝶呤化療和大劑量甲氨蝶呤聯(lián)合全腦放射治療，患者的中位生存期分別為22、25和30個月，術后未接受化療和放療者中位生存期僅4.5個月。 4．PCNSL患者的預后與治療方案明顯有關（P0.05）。手術切除腫瘤后采用大劑量甲氨蝶呤聯(lián)合全腦放射治療，能顯著延長患者生存。
[Abstract]:Primary central nervous system lymphomatosis (PCNSLL) is a rare malignant tumor of the central nervous system. At present, the clinical diagnosis is still difficult and the therapeutic effect is not satisfactory.The main points of diagnosis and effective treatment have important clinical value.Objective: to analyze the clinical features and therapeutic effects of PCNSL in order to improve the diagnosis and treatment of the disease.Methods: PCNSL25 cases were collected from September 2009 to September 2011 in the Department of Neurooncology, the first Hospital of Jilin University. The age, sex, onset time, imaging data, surgical treatment and pathological data of the patients were analyzed.The data of systemic radiotherapy and chemotherapy and the prognosis of the patients were analyzed retrospectively.Results: all of the 25 cases had no history of organ transplantation, and all the patients were negative for HIV antibody in malignant tumor and autoimmune disease. Among them, 17 were male and 8 female, male: 2.1: 1; the age of onset was 1273 (mean 52.4) years.Among them, 18 cases were 50 years old and 2 cases were 18 years old, which accounted for 80. 0% of the total patients.The course of disease ranged from 6 days to 10 months with an average of 3 months.PCNSLs were diagnosed according to the clinical manifestations and MRI findings.All patients underwent surgical resection of tumor in 17 cases and partial resection in 8 cases.Histopathological examination showed that 21 cases of diffuse large B cell lymphoma (84%) were small B cell lymphoma (12 cases), and 1 case (20 0) of T lymphocyte lymphoma (4 cases) received whole brain radiotherapy. The survival time was 13 ~ 32 months.The median survival time was 30 months or 8 patients (32.0). The shortest survival time was 3 ~ 7 months, and the median survival time was 4.5 months.Conclusion:1.The male and female ratio of 25 PCNSL patients was 2.1: 1, the mean age of onset was 52.4 years old and over 50 years old, 18 cases were over 50 years old, the course of disease was from 6 days to 10 months.2.Plain MRI and enhanced MRI is the most valuable method for the diagnosis of PCNSL.3.After resection of tumor, only whole brain radiotherapy was accepted. The median survival time of the patients was 22 ~ 25 months and 30 months, respectively. The patients were treated with high dose methotrexate chemotherapy and high dose methotrexate combined with global brain radiotherapy.The median survival time of patients without chemotherapy or radiotherapy was 4.5 months.The prognosis of 4.PCNSL patients was significantly related to the treatment plan (P 0.05).High dose methotrexate combined with whole brain radiotherapy can significantly prolong survival after resection of tumor.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R739.4

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相關期刊論文 前2條

1 涂金花;姚麗青;余英豪;;原發(fā)性中樞神經系統(tǒng)彌漫大B細胞性淋巴瘤16例臨床病理分析[J];臨床與實驗病理學雜志;2011年10期

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