咽喉部假性淋巴瘤与黏膜相关淋巴组织淋巴瘤的临床研究

发布时间：2018-03-08 07:13

  本文选题：咽　切入点：喉部肿瘤　出处：《福建医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 【目的】 对咽喉部假性淋巴瘤(Pseudolymphoma,PL)与黏膜相关淋巴组织淋巴瘤(Mucosa-associated lymphoid tissue lymphoma, MALT-MZL)——这两种紧密关联又十分罕见的疾病进行研究,探讨它们的发病机制、临床特点、诊断、治疗策略及预后,提高临床医师对其的认识及诊治。 【方法】 回顾性分析2007年10月至2009年5月福建省立医院耳鼻咽喉科收治的咽喉部1例PL与3例MALT-MZL患者的临床资料。1例PL患者病变累及双侧扁桃体、舌根、会厌及喉咽,治疗采用低温等离子射频消融+激光切除肿物+术后辅助化疗的方法。3例MALT-MZL患者,病变分别累及左室带及喉室、右室带及舌会厌溪,治疗均采用传统手术切除辅以术后化疗的方法治疗。4例患者术后、化疗后均无明显并发症,效果满意。通过中英文医学文献检索系统,全面收集与筛选国内外已发表的相关文献,提取临床资料并结合我科病例进行系统分析,归纳出两种疾病的临床特点并提出治疗策略。 【结果】 1、1例咽喉部PL患者随访21个月,未见肿瘤复发。3例咽/喉部MALT-MZL患者分别随访29、17及10个月,均未见肿瘤复发或向高度恶性转化。 2、国内外共报道7例咽喉部PL,结合我科1例进行分析。该组患者男4例,女4例,年龄36-68岁,同时累及咽、喉部3例,咽部1例,喉部3例,咽旁间隙1例。治疗上采用手术切除4例,放疗2例,化疗1例,手术切除+化疗1例。除1例文中未提及,余7例随访时间2个月-7年,中位数21个月,均未见肿瘤复发。咽部MALT-MZL共43例,绝大部分为病理科医师报道,缺乏临床资料。喉部原发性MALT-MZL 16例,结合我科2例进行分析。该组患者男10例,女8例,年龄25-79岁,累及声门上区者13例,声门区者1例,声门下区者4例。治疗上采用手术切除2例,放疗3例,化疗3例,手术切除+放疗5例,手术切除+化疗2例,手术切除+保守治疗1例,放疗+化疗1例,手术切除+放疗+化疗1例。除3例文中未提及,余15例随访时间6个月-12年,中位数2年,均未见肿瘤复发或向高度恶性转化。 【结论】 1、咽喉部PL与MALT-MZL是紧密关联又十分罕见的两种疾病,好发于中老年患者。由于二者是一个逐渐演进的过程,临床特征及影像学检查无明显区别,故临床上相互鉴别十分困难。目前诊断主要靠活检或术后病理学检查结合免疫组织化学染色证实,必要时应行基因重排检查加以鉴别。 2、对于咽喉部PL和Ann ArborⅠE期的MALT-MZL患者,若肿物不大,治疗上推荐先给予标准的抗幽门螺旋杆菌治疗,疗程结束后进行评估,若无明显改善,再考虑行手术切除或局部放疗;若肿物较大,引起明显的呼吸困难,可先行气管切开,然后再行进一步处理。低温等离子刀和激光可成为一种新的手术工具应用于二者的手术治疗中。单纯放疗剂量推荐在30-50Gy。对于全身多器官累及或术后全身复发的患者可考虑化疗。PL有向恶性进展的可能,MALT-MZL有向高度恶性转化的可能,故二者均需要长期密切的随访。
[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.
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