本文選題：原發(fā)性胃淋巴瘤　切入點：內(nèi)鏡　出處：《山東大學》2017年碩士論文

【摘要】：目的:鑒于原發(fā)性胃淋巴瘤(primary gastric lymphoma,PGL)內(nèi)鏡下診斷率低,本研究旨在通過分析山東地區(qū)多中心病理確診及內(nèi)鏡下疑診原發(fā)性胃淋巴瘤的內(nèi)鏡資料及病理診斷,提高對內(nèi)鏡醫(yī)師對PGL內(nèi)鏡下特點的認識,以降低內(nèi)鏡醫(yī)師對原PGL的誤診、漏診,從而提高術(shù)前診斷率。方法:選取山東8家醫(yī)院(山東大學齊魯醫(yī)院、臨沂市人民醫(yī)院、濱州市人民醫(yī)院、淄博市第一人民醫(yī)院、威海市立醫(yī)院、菏澤市立醫(yī)院、濟寧市第一人民醫(yī)院、聊城市人民醫(yī)院等)2008年6月至2015年3月期間行胃鏡檢查后經(jīng)病理確診的PGL但內(nèi)鏡下未考慮PGL及內(nèi)鏡下疑診PGL患者282例,回顧性分析其內(nèi)鏡資料、病理資料,包括免疫組化切片和HE切片。本研究共入組的282例患者,包括112例內(nèi)鏡下未疑診但病理確診患者,設(shè)為內(nèi)鏡下未疑診組;另外170例內(nèi)鏡下疑診原發(fā)性胃淋巴瘤,但病理確診或排除原發(fā)性胃淋巴瘤患者,設(shè)為內(nèi)鏡下疑診組。比較疑診組與未疑診組PGL患者內(nèi)鏡下的表現(xiàn),分析不同內(nèi)鏡下特征與確診PGL之間的相關(guān)性。結(jié)果:1.病理類型均為非霍奇金淋巴瘤,未見霍奇金淋巴瘤,其中彌漫性大B淋巴瘤比例最高,約占50%;T細胞淋巴瘤少見;漿細胞淋巴瘤和套細胞淋巴瘤均屬于罕見病理類型。2.內(nèi)鏡下未疑診組與疑診組比較,發(fā)病的中位年齡接近;鏡下病變表現(xiàn)惡性征,臨床癥狀為消化道出血,則傾向于PGL的診斷。3.疑診組與未疑診組病變部位均以單發(fā)為主,且胃體、胃竇多見。病變?yōu)閺浡圆∽冋?或單部位病變且病變僅在胃竇或胃角者,病理診斷為原發(fā)性胃淋巴瘤概率增加。4.兩組內(nèi)鏡下基本病變形態(tài)均包括以下4種:潰瘍型、浸潤型、腫塊型、粘膜皺襞粗大型。未疑診組與疑診組均以潰瘍型為主(58.9%,39.4%),其次為腫塊型(26.8%,24.1%)。數(shù)據(jù)分析顯示:潰瘍型病變特別是巨大潰瘍,傾向于原發(fā)性胃淋巴瘤的診斷;而胃鏡下浸潤型病變及皺襞粘膜粗大型病變,診斷原發(fā)性胃淋巴瘤的概率降低。5.內(nèi)鏡下病變質(zhì)地質(zhì)地硬,病理診斷為胃淋巴瘤的傾向性增加。病變質(zhì)地軟、韌、脆等均無差異性。6.胃黏膜相關(guān)組織淋巴瘤(MALT)患者Hp感染陽性率較高。胃癌及其他類型胃淋巴瘤患者HP檢出率較低。結(jié)論:原發(fā)性胃淋巴瘤病理類型以B細胞型為主,彌漫大B細胞瘤最多見。40-49歲為發(fā)病的高峰年齡段。內(nèi)鏡下病變以單部位為主,單部位中以胃竇、胃體最多;且有4種病變形態(tài):潰瘍型、浸潤型、腫塊型、粘膜皺襞粗大型,潰瘍型最多。其中,MALT與Hp感染有明顯相關(guān)性。內(nèi)鏡對原發(fā)性胃淋巴瘤診斷率低,需多點、深挖、多次活檢以提高診斷率。
[Abstract]:Objective: in view of the low rate of endoscopic diagnosis of primary gastric lymphoma, the purpose of this study was to analyze the endoscopic data and pathological diagnosis of primary gastric lymphoma diagnosed by multi-center pathology and suspected by endoscope. In order to reduce the misdiagnosis and missed diagnosis of PGL by endoscopers and improve the preoperative diagnosis rate, 8 hospitals (Qilu Hospital, Shandong University, people's Hospital of Linyi City) were selected. Binzhou people's Hospital, Zibo first people's Hospital, Weihai Municipal Hospital, Heze Municipal Hospital, Jining first people's Hospital, From June 2008 to March 2015, 282 patients with PGL confirmed by pathology were examined by gastroscopy, but PGL and suspected PGL were not considered under endoscope. The endoscopic data and pathological data were analyzed retrospectively. In this study, 282 patients were included, including 112 patients without suspected diagnosis under endoscope but pathologically confirmed, and 170 patients with suspected primary gastric lymphoma under endoscope. However, the patients with primary gastric lymphoma diagnosed or excluded by pathology were divided into two groups: the suspected group and the unsuspected group. The endoscopic manifestations of the patients with PGL were compared between the suspected group and the unsuspected group. The correlation between different endoscopic features and the diagnosis of PGL was analyzed. Results 1. All the pathological types were non-Hodgkin 's lymphoma, and no Hodgkin's lymphoma was found, of which diffuse large B lymphoma was the highest, accounting for about 50% of T cell lymphoma. Plasma cell lymphoma and mantle cell lymphoma belong to the rare pathological type .2.Compared with the suspected group, the median age of the disease is close to that of the endoscopic unsuspected group, the pathological changes under the microscope are malignant sign, and the clinical symptom is gastrointestinal hemorrhage. The lesions of the suspected group and the unsuspected group were mainly single, and the gastric body and antrum were more common. The lesion was diffuse, or the lesion was only in the antrum or the horn of stomach. The probability of pathological diagnosis of primary gastric lymphoma increased .4.The basic pathological changes in both groups included the following four types: ulcer type, infiltrating type, mass type, and so on. The mucosal folds were thick and large. In both the unsuspected group and the suspected group, the main types were ulcer type (58.9%), followed by mass type (26.8%). Data analysis showed that ulcerative lesions, especially giant ulcers, tended to diagnose primary gastric lymphoma. However, the probability of diagnosis of primary gastric lymphoma was decreased by gastroscopic invasive lesions and coarse and large lesions of plica mucosa. 5. The texture of endoscopic lesions was hard, the tendency of pathological diagnosis of gastric lymphoma was increased, and the lesions were soft and tough. The positive rate of HP infection was higher in patients with gastric mucosa-associated tissue lymphoma (MALTT), and the detection rate of HP was lower in patients with gastric cancer and other types of gastric lymphoma. Conclusion: the pathological type of primary gastric lymphoma is B cell type. Diffuse large B cell tumors are most common in the peak age group of 40 to 49 years of age. Endoscopic lesions are mainly located in a single site, with antrum and body being the most common, and there are four types of lesions: ulcer type, infiltrating type, mass type, thick and large mucosal fold. The diagnosis rate of primary gastric lymphoma by endoscopy is low, it needs many points, deep digging and multiple biopsies to improve the diagnostic rate.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.2

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