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目的分析以肠道症状就诊的T/NK细胞非霍奇金淋巴瘤(NHL)的临床和内镜特点,以提高对该疾病的认识。方法总结回顾本院38例以肠道症状就诊的T/NK细胞NHL病例临床资料,分析其临床和内镜特点。结果肠道主要首发症状为单纯腹痛或腹胀/腹部不适(11例)、腹痛伴有便血(12例)、腹痛伴有腹泻(11例)、腹痛伴腹部包块(2例)、黑便(2例)。有B症状者30例,IPI评分为高危和高中危的患者33例。约一半患者LDH、ESR、CRP增高。31例患者行手术,主要原因为穿孔(19例)。病变累及大肠12例,小肠15例,回盲部7例,小肠和大肠均受累4例。病变类型中多发弥漫溃疡为12例,局限性溃疡10例,肿块/占位11例,黏膜病变4例,其他病变1例。病理类型以周围T细胞淋巴瘤-非特指型(PTCL-U)多见。对于原发肠道T/NK细胞性NHL,病变累及大肠10例,回盲部3例,小肠8例,多部位受累3例;病变类型以多发弥漫溃疡型为主(9例)。结论 T/NK细胞淋巴瘤在小肠和大肠均常见,病变类型以多发弥漫溃疡和占位为主。临床工作中对以腹痛为主要表现,伴有B症状、LDH、ESR、CRP增高,病情进展快的患者,应警惕T/NK-NHL的可能,争取早期确诊。
Objective To analyze the clinical and endoscopic features of T / NK cell non-Hodgkin’s lymphoma (NHL) treated with intestinal symptoms to improve their understanding of the disease. Methods The clinical data of 38 NHL patients with T / NK cell treated by intestinal symptoms were retrospectively reviewed. The clinical and endoscopic features were analyzed. Results The main symptoms of the intestine were abdominal pain or bloating / abdominal discomfort (11 cases), abdominal pain with blood in the stool (12 cases), abdominal pain with diarrhea (11 cases), abdominal pain with abdominal mass (2 cases) 2 cases). There were 30 cases with symptoms of B and 33 cases with high and high risk of IPI. About half of patients with LDH, ESR, CRP increased. Thirty-one patients underwent surgery, primarily due to perforation (n = 19). Lesions involving the large intestine in 12 cases, 15 cases of small intestine, 7 cases of ileocecal, small intestine and large intestine were involved in 4 cases. Multiple lesions in the type of diffuse ulcers in 12 cases, 10 cases of localized ulcers, mass / space in 11 cases, mucosal lesions in 4 cases, and other lesions in 1 case. Pathological types of peripheral T-cell lymphoma - non-specific type (PTCL-U) more common. For the primary intestinal T / NK cell NHL, the lesions involved 10 cases of large intestine, 3 cases of ileocecal, 8 cases of small intestine and 3 cases of multi-site involvement. The lesions were mainly diffuse ulcer (9 cases). Conclusion T / NK cell lymphomas are common in the small intestine and large intestine. The main types of lesions are multiple diffuse ulceration and space occupying. Clinical work to abdominal pain as the main performance, accompanied by B symptoms, LDH, ESR, CRP increased, rapid progression of patients should be alert to the possibility of T / NK-NHL for early diagnosis.