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中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (03) : 173 -176. doi: 10.3877/cma.j.issn.2095-3232.2016.03.011

所属专题: 文献

临床研究

原发性肝淋巴瘤诊断与治疗
徐理华1, 刘瑞明2, 黄群爱3, 刘瑞磊3,()   
  1. 1. 510230 广州医科大学附属第一医院血液科
    2. 510080 广州,中山大学附属第一医院外科实验室
    3. 510630 广州,中山大学附属第三医院甲乳外科
  • 收稿日期:2016-02-17 出版日期:2016-06-10
  • 通信作者: 刘瑞磊
  • 基金资助:
    广东省自然科学基金(2015A030310126)

Diagnosis and treatment of primary hepatic lymphoma

Lihua Xu1, Ruiming Liu2, Qun'ai Huang3, Ruilei Liu3,()   

  1. 1. Department of Hematology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China
    2. Laboratory of Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
    3. Department of Thyroid and Breast Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2016-02-17 Published:2016-06-10
  • Corresponding author: Ruilei Liu
  • About author:
    Corresponding author: Liu Ruilei, Email:
引用本文:

徐理华, 刘瑞明, 黄群爱, 刘瑞磊. 原发性肝淋巴瘤诊断与治疗[J/OL]. 中华肝脏外科手术学电子杂志, 2016, 05(03): 173-176.

Lihua Xu, Ruiming Liu, Qun'ai Huang, Ruilei Liu. Diagnosis and treatment of primary hepatic lymphoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(03): 173-176.

目的

探讨原发性肝淋巴瘤(PHL)的临床诊断、治疗及预后。

方法

回顾性分析2008年3月至2015年12月中山大学附属第三医院收治的9例PHL患者临床资料。其中男6例,女3例;年龄46~61岁,中位年龄53岁。患者均签署知情同意书,符合医学伦理学规定。分析其临床表现、诊断经过、治疗方案及预后。

结果

9例患者中,4例因发现肝占位性病变就诊,3例上腹痛,2例伴发热;9例合并慢性乙型病毒性肝炎(乙肝)。3例术前血清乳酸脱氢酶升高。超声检查表现为肝内低回声实质光团,CT平扫显示肝内低密度病灶。9例患者均经病理学检查确诊。2例行单纯手术切除,2例行手术+化疗,5例行肝穿刺活检+化疗。截止至投稿日期,存活6例,其中生存时间超过12个月者4例。

结论

PHL临床及影像学表现无特异性,确诊需依靠病理学检查,手术切除联合化疗是有效的治疗方法。

Objective

To investigate the clinical diagnosis, treatment and prognosis of primary hepatic lymphoma (PHL).

Methods

Clinical data of 9 patients with PHL who admitted and treated in the Third Affiliated Hospital of Sun Yat-sen University between March 2008 and December 2015 were retrospectively analyzed. Among the patients, 6 were males and 3 were females with the age ranging from 46 to 61 years old and the median of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The clinical manifestation, diagnosis procedure, therapeutic regimen and prognosis of the patients were analyzed.

Results

Among the 9 patients, 4 cases saw the doctor for the finding of a hepatic space-occupying lesion, 3 cases for epigastric pain, and 2 cases for fever. Nine cases were complicated with chronic viral hepatitis B (HBV). Elevated preoperative serum lactate dehydrogenase was observed in 3 cases. Ultrasound examination indicated a hypoechoic echogenic mass in the liver, and plain CT scan indicated a low-density lesion in the liver. The diagnosis of all 9 patients was confirmed by the pathological examination. Two cases underwent simple resection, 2 underwent resection + chemotherapy and 5 underwent liver biopsy + chemotherapy. By the paper submission date, 6 patients survived and 4 of them survived more than 12 months.

Conclusions

The clinical manifestation and imaging findings of PHL are non-specific. Confirmed diagnosis depends on the pathological examination, and surgical resection combined with chemotherapy is an effective treatment.

表1 九例原发性肝淋巴瘤患者临床资料
例序 性别 年龄(岁) 临床表现 ALT 乳酸脱氢酶 肝炎病史 诊断 治疗 随访
1 44 右上腹部隐痛2个月余 升高 正常 乙肝 肝边缘区B细胞淋巴瘤 肝Ⅳ段肿瘤切除+胆囊切除术,R-CHOP方案化疗进行中 随访2个月,存活
2 58 右上腹隐痛,乏力纳差2个月 升高 未查 乙肝 肝低级别滤泡性淋巴瘤 肝左外叶切除+胆囊切除术 随访6个月,存活
3 53 反复发热10余天,发现肝占位1 d 正常 升高 乙肝 肝弥漫性大B细胞淋巴瘤 肝穿刺活检,R-CHOP方案化疗6个疗程+CIK治疗 随访17个月,存活
4 57 发现肝占位1 d 正常 正常 乙肝 肝MALT淋巴瘤 肝Ⅴ段肿瘤切除+肝Ⅳ/Ⅷ段肿瘤切除+胆囊切除术,R-CHOP方案化疗4个疗程 随访61个月,存活
5 54 乏力、纳差1个月余,伴发热3周 正常 正常 乙肝 肝弥漫性大B细胞淋巴瘤 肝穿刺活检,R-CHOP方案化疗6个疗程 随访21个月,骨髓浸润死亡
6 52 发现肝占位1周 升高 升高 乙肝 肝弥漫性大B细胞淋巴瘤 肝穿刺活检,R-CHOP方案化疗6个疗程 随访36个月,存活
7 46 发现肝脾占位5 d 正常 升高 乙肝 肝Burkitt淋巴瘤 肝穿刺活检,利妥昔单抗+Hyper CVAD方案化疗4个疗程 随访10个月,淋巴瘤复发与扩散死亡
8 61 发现肝占位1周 正常 未查 乙肝 肝弥漫性大B细胞淋巴瘤 肝Ⅵ/Ⅶ段肿瘤切除+胆囊切除术 随访14个月,淋巴瘤复发与扩散死亡
9 53 左上腹部胀痛1个月余 正常 未查 乙肝 肝弥漫性大B细胞淋巴瘤 肝穿刺活检,CHOP方案化疗8个疗程 随访82个月,存活
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