以十二指肠球部溃疡为表现的淋巴瘤：3例报告和文献复习

发布时间：2018-01-01 01:00

本文关键词：以十二指肠球部溃疡为表现的淋巴瘤：3例报告和文献复习　出处：《浙江大学》2015年硕士论文　论文类型：学位论文

【摘要】：1、背景和目的消化性溃疡是临床上的常见疾病,其中十二指肠球部溃疡(DU)一般是以良性病变为主,临床治疗后大部分都能得到改善。但有部分DU在常规治疗后未能得到改善,这时需警惕以十二指肠球部溃疡为表现的少见疾病。本文对十二指肠内球部溃疡表现的少见疾病进行鉴别诊断,并通过3例在我院诊治的和国内报道的类似的10例病例总计13例的十二指肠球部溃疡表现的淋巴瘤进行分析,提高对十二指肠球部溃疡表现的少见疾病尤其是淋巴瘤的认识和诊治水平。 2、方法对2006-2015年间我院诊治的3例以十二指肠球部溃疡为表现的淋巴瘤和国内近20年报道的10例相似病例进行归纳总结,并对以十二指肠溃疡表现的少见疾病如克罗恩病、结核病、腺癌、嗜酸性粒细胞性胃肠炎、Z ollinger Ellison综合症进行鉴别诊断。 3、结果 13例患者中,男性8例,占61.5%(8/13),女性5例,占38.5%(5/13),年龄最小25岁,最大年龄77岁,平均年龄为50+27岁,中位年龄为52岁。13例患者主诉中,10例患者均有腹部不适或疼痛,其中40%(4/10)诉与进食相关；3例患者主诉中有黑便,2例主诉有呕血。13例患者胃镜检查中均有十二指肠球部溃疡表现。13例病人病理诊断中,明确诊断为DLBCL有7例；3例报道指出是B型非霍奇金淋巴瘤,未进行明确分类；1例指出是NHL未进行具体报告,1例为小B细胞淋巴瘤,1例为霍奇金淋巴瘤。治疗方面其中6例单纯行化疗,6例单纯行手术治疗,1例行手术后放化疗。 4、结论十二指肠球部溃疡是最常见的消化道溃疡,但是有一部分以十二指肠球部溃疡为表现的少见疾病在临床上需要加强警惕和认识。十二指肠球部溃疡为表现的淋巴瘤早期诊断的关键在于药物治疗后的复查和足够的警惕性,内镜下或超声胃镜下活检是其主要确诊手段；病理类型以弥漫大B细胞淋巴瘤为主,目前手术治疗结合化疗是主要的治疗方法。
[Abstract]:1, background and purpose
Peptic ulcer is a common clinical disease, including duodenal ulcer (DU) in general is a benign lesion, most clinical treatment can be improved. But there are some DU failed to improve in the routine treatment, then need to be alert for rare disease manifestations in duodenal ulcer. This rare disease of duodenum in the differential diagnosis of duodenal ulcer, and through 3 cases in our hospital and reported similar total 10 cases of duodenal ulcer manifestation in 13 cases of lymphoma were analyzed, the performance of the twelve refers to a rare disease of intestinal ulcer especially is diagnosis and therapy of lymphoma.
2, method
During the period of 2006-2015 in our hospital for diagnosis and treatment of 3 cases with duodenal ulcer as a manifestation of lymphoma and the recent 20 years in China reported 10 cases of similar cases are summarized, and the rare disease with duodenal ulcer manifestations such as Crohn's disease, tuberculosis, cancer, eosinophilic gastroenteritis, Z ollinger syndrome Ellison differential diagnosis.
3, the result
In 13 patients, 8 cases were male, accounting for 61.5% (8/13), 5 cases of women, accounting for 38.5% (5/13), the youngest 25 years old, the maximum age of 77 years old, the average age was 50+27 years old, the median age was 52 years old.13 patients complained, 10 patients had abdominal pain or discomfort, which 40% v. (4/10) associated with eating; 3 patients complained of melena, 2 cases complained of hematemesis.13 patients in gastroscopy were duodenal ulcer patients showed.13 pathological diagnosis, diagnosed as DLBCL 7 cases; 3 cases reported that B non Hodgkin's lymphoma is not clear classification; 1 cases of pointed out that NHL is not specific report, 1 cases of small B cell lymphoma, 1 cases of Hodgkin lymphoma. The treatment including 6 cases underwent chemotherapy, 6 cases underwent surgical treatment, 1 cases underwent chemotherapy after surgery.
4. Conclusion
Duodenal ulcer is the most common digestive tract ulcer, but some rare diseases characterized by duodenal bulb ulcer need to be vigilant and recognized clinically.
The key to early diagnosis of lymphoma of the duodenal ulcer is drug treatment after review and sufficient vigilance, or endoscopic biopsy under ultrasonic gastroscopy is the main means of diagnosis; pathological types of diffuse large B cell lymphoma, surgical treatment combined with chemotherapy is the main treatment method.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R573.1;R735.31

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