本文選題：咽　切入點(diǎn)：喉部腫瘤　出處：《福建醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 【目的】 對(duì)咽喉部假性淋巴瘤(Pseudolymphoma,PL)與黏膜相關(guān)淋巴組織淋巴瘤(Mucosa-associated lymphoid tissue lymphoma, MALT-MZL)——這兩種緊密關(guān)聯(lián)又十分罕見(jiàn)的疾病進(jìn)行研究,探討它們的發(fā)病機(jī)制、臨床特點(diǎn)、診斷、治療策略及預(yù)后,提高臨床醫(yī)師對(duì)其的認(rèn)識(shí)及診治。 【方法】 回顧性分析2007年10月至2009年5月福建省立醫(yī)院耳鼻咽喉科收治的咽喉部1例PL與3例MALT-MZL患者的臨床資料。1例PL患者病變累及雙側(cè)扁桃體、舌根、會(huì)厭及喉咽,治療采用低溫等離子射頻消融+激光切除腫物+術(shù)后輔助化療的方法。3例MALT-MZL患者,病變分別累及左室?guī)Ъ昂硎摇⒂沂規(guī)Ъ吧鄷?huì)厭溪,治療均采用傳統(tǒng)手術(shù)切除輔以術(shù)后化療的方法治療。4例患者術(shù)后、化療后均無(wú)明顯并發(fā)癥,效果滿意。通過(guò)中英文醫(yī)學(xué)文獻(xiàn)檢索系統(tǒng),全面收集與篩選國(guó)內(nèi)外已發(fā)表的相關(guān)文獻(xiàn),提取臨床資料并結(jié)合我科病例進(jìn)行系統(tǒng)分析,歸納出兩種疾病的臨床特點(diǎn)并提出治療策略。 【結(jié)果】 1、1例咽喉部PL患者隨訪21個(gè)月,未見(jiàn)腫瘤復(fù)發(fā)。3例咽/喉部MALT-MZL患者分別隨訪29、17及10個(gè)月,均未見(jiàn)腫瘤復(fù)發(fā)或向高度惡性轉(zhuǎn)化。 2、國(guó)內(nèi)外共報(bào)道7例咽喉部PL,結(jié)合我科1例進(jìn)行分析。該組患者男4例,女4例,年齡36-68歲,同時(shí)累及咽、喉部3例,咽部1例,喉部3例,咽旁間隙1例。治療上采用手術(shù)切除4例,放療2例,化療1例,手術(shù)切除+化療1例。除1例文中未提及,余7例隨訪時(shí)間2個(gè)月-7年,中位數(shù)21個(gè)月,均未見(jiàn)腫瘤復(fù)發(fā)。咽部MALT-MZL共43例,絕大部分為病理科醫(yī)師報(bào)道,缺乏臨床資料。喉部原發(fā)性MALT-MZL 16例,結(jié)合我科2例進(jìn)行分析。該組患者男10例,女8例,年齡25-79歲,累及聲門上區(qū)者13例,聲門區(qū)者1例,聲門下區(qū)者4例。治療上采用手術(shù)切除2例,放療3例,化療3例,手術(shù)切除+放療5例,手術(shù)切除+化療2例,手術(shù)切除+保守治療1例,放療+化療1例,手術(shù)切除+放療+化療1例。除3例文中未提及,余15例隨訪時(shí)間6個(gè)月-12年,中位數(shù)2年,均未見(jiàn)腫瘤復(fù)發(fā)或向高度惡性轉(zhuǎn)化。 【結(jié)論】 1、咽喉部PL與MALT-MZL是緊密關(guān)聯(lián)又十分罕見(jiàn)的兩種疾病,好發(fā)于中老年患者。由于二者是一個(gè)逐漸演進(jìn)的過(guò)程,臨床特征及影像學(xué)檢查無(wú)明顯區(qū)別,故臨床上相互鑒別十分困難。目前診斷主要靠活檢或術(shù)后病理學(xué)檢查結(jié)合免疫組織化學(xué)染色證實(shí),必要時(shí)應(yīng)行基因重排檢查加以鑒別。 2、對(duì)于咽喉部PL和Ann ArborⅠE期的MALT-MZL患者,若腫物不大,治療上推薦先給予標(biāo)準(zhǔn)的抗幽門螺旋桿菌治療,療程結(jié)束后進(jìn)行評(píng)估,若無(wú)明顯改善,再考慮行手術(shù)切除或局部放療;若腫物較大,引起明顯的呼吸困難,可先行氣管切開(kāi),然后再行進(jìn)一步處理。低溫等離子刀和激光可成為一種新的手術(shù)工具應(yīng)用于二者的手術(shù)治療中。單純放療劑量推薦在30-50Gy。對(duì)于全身多器官累及或術(shù)后全身復(fù)發(fā)的患者可考慮化療。PL有向惡性進(jìn)展的可能,MALT-MZL有向高度惡性轉(zhuǎn)化的可能,故二者均需要長(zhǎng)期密切的隨訪。
[Abstract]:[Objective]
The throat pseudolymphoma (Pseudolymphoma, PL) and mucosa associated lymphoid tissue lymphoma (Mucosa-associated lymphoid tissue lymphoma, MALT-MZL) - these two closely related and very rare disease research, and investigate the pathogenesis of the clinical features, diagnosis, treatment and prognosis of clinicians to improve strategies, its diagnosis and treatment.
[method]
A retrospective analysis from October 2007 to May 2009 in Fujian Province-owned Hospital Department of Otolaryngology from the throat of 1 cases of PL and 3 cases of MALT-MZL patients with clinical data of.1 cases of PL patients with lesions involving bilateral tonsils, tongue, epiglottis and hypopharynx, treated with plasma radiofrequency ablation and laser cutting method of adjuvant chemotherapy after resection of tumor and.3 patients with MALT-MZL. The lesions were in the left ventricular and right ventricular chamber throat, tongue and epiglottis Creek, were treated by traditional surgery and postoperative chemotherapy in the treatment of.4 patients after chemotherapy, there was no obvious complication, with satisfactory results. The retrieval system by English medical literature, a comprehensive collection of relevant literature at home and abroad and screening the published clinical data, extraction and system analysis combined with cases, summarized the clinical characteristics of two kinds of diseases and propose the treatment strategies.
[results]
1,1 patients with PL were followed up for 21 months. No tumor recurrences were observed..3 patients with pharyngeal / laryngeal MALT-MZL were followed up for 29,17 and 10 months. No recurrence or transformation to high malignancy occurred.
2,鍥藉唴澶栧叡鎶ラ亾7渚嬪捊鍠夐儴PL,緇撳悎鎴戠1渚嬭繘琛屽垎鏋，

本文編號(hào)：1582899