小肠原发性恶性淋巴瘤的CT诊断及对患者胃肠功能的影响
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摘要
目的探讨小肠原发性恶性淋巴瘤的CT诊断效果及对患者胃肠功能的影响。方法选择2016年6月～2018年6月入院诊断治疗的小肠原发性恶性淋巴瘤患者20例,所有患者均行手术治疗,且患者均经过手术病理检查最终得到确诊。手术前患者采用多层螺旋CT检查。记录患者手术后首次排气、排便、首次进食、腹痛腹胀缓解、住院及WBC恢复时间。结果 20例小肠原发性恶性淋巴瘤患者均经过手术病理检查最终得到确诊。患者中,发病部位排在前两位的分别为小肠、结肠;病理类型主要以免疫表型B细胞淋巴瘤为主,占85.00%;20例患者均顺利完成CT检查,CT下将小肠原发性恶性淋巴瘤分为肠壁增厚型、动脉瘤样扩张型、息肉肿块型及肠系膜浸润型四种类型。20例患者中8例肠壁增厚型,CT下可见肠壁不规则增厚,厚度1.4～4.0cm,部分患者可见病变肠管出现不同程度狭窄;动脉瘤样扩张型7例,CT下未见管腔狭窄,部分患者可见明显的扩张,呈"动脉瘤样"增强扫描下病灶部位肠管、肿大均出现不同程度强化;息肉样肿块型3例,CT下可见息肉状软组织肿块影,形状相对规则呈分叶状;增强扫描可见病灶部位形态规则或多呈分叶状,增强扫描下可见病灶轻度强化;肠系膜浸润型2例,CT下可见肠系膜增厚,脂肪间隙密度增高;20例患者均完成手术治疗,手术后首次排气排便时间(23.51±4.52)h、首次进食时间(13.27±2.31)h、腹痛腹胀缓解时间(14.69±3.21)h、住院时间(12.14±3.42)d。结论将CT用于小肠原发性恶性淋巴瘤患者中能帮助患者早期确诊,有助于改善患者术后胃肠功能,值得推广应用。
Objective To investigate the CT diagnosis of primary small intestinal malignant lymphoma and its effect on gastrointestinal function. Methods 20 patients with primary intestinal lymphoma who were diagnosed and admitted to hospital from June 2016 to June 2018 were selected.All the patients underwent surgical treatment and the patients were finally confirmed by surgical pathology.Patients were used multi-slice spiral CT before surgery.The first time after the operation of patients with exhaust,defecation,the first eating,abdominal pain,abdominal distension relief,hospitalization and WBC recovery time were recorded. Results 20 cases of primary small intestinal malignant lymphoma were confirmed by surgical pathology.The incidence of the top two were the small intestine,colon;Pathological type mainly immunophenotypic B cell lymphoma,accounting for 85.00%.All the 20 patients successfully completed the CT examination,which classified the primary malignant lymphoma of the small intestine into four types:intestinal wall thickening type,aneurysmal dilation type,polyp mass type and mesenteric infiltration type.Among the 20 patients,8 cases had intestinal wall thickening.Irregular intestinal wall thickening was observed under CT,with a thickness of 1.4-4.0 cm.Some patients showed different degrees of stenosis in the diseased intestinal tubes.7 patients with aneurysmal dilatation,no lumen stenosis was observed under CT,and obvious dilatation was observed in some patients,showing different degrees of enhancement of intestinal tube and enlargement at the lesion site under "aneurysmal" enhancement scan.There were 3 cases of polypoid mass type,and the soft tissue mass shadow of polypoid was seen under CT,and the shape was relatively regular and lobulated.The morphology of the lesion was regular or lobulated on enhanced scan,and mild enhancement was observed on enhanced scan.2 cases of mesenteric infiltration,the mesentery was thickened and the density of fat space was increased under CT.All the 20 patients completed the surgical treatment,including the time of first exhaust and defecation(23.51±4.52)h,time of first meal(13.27±2.31)h,time of relief of abdominal pain and abdominal distension(14.69±3.21)h,time of hospitalization(12.14±3.42)days. Conclusion The use of computed tomography in patients with primary small intestinal malignant lymphoma can help patients diagnose early and improve postoperative gastrointestinal function,which is worthy of promotion and application.
Objective To investigate the CT diagnosis of primary small intestinal malignant lymphoma and its effect on gastrointestinal function. Methods 20 patients with primary intestinal lymphoma who were diagnosed and admitted to hospital from June 2016 to June 2018 were selected.All the patients underwent surgical treatment and the patients were finally confirmed by surgical pathology.Patients were used multi-slice spiral CT before surgery.The first time after the operation of patients with exhaust,defecation,the first eating,abdominal pain,abdominal distension relief,hospitalization and WBC recovery time were recorded. Results 20 cases of primary small intestinal malignant lymphoma were confirmed by surgical pathology.The incidence of the top two were the small intestine,colon;Pathological type mainly immunophenotypic B cell lymphoma,accounting for 85.00%.All the 20 patients successfully completed the CT examination,which classified the primary malignant lymphoma of the small intestine into four types:intestinal wall thickening type,aneurysmal dilation type,polyp mass type and mesenteric infiltration type.Among the 20 patients,8 cases had intestinal wall thickening.Irregular intestinal wall thickening was observed under CT,with a thickness of 1.4-4.0 cm.Some patients showed different degrees of stenosis in the diseased intestinal tubes.7 patients with aneurysmal dilatation,no lumen stenosis was observed under CT,and obvious dilatation was observed in some patients,showing different degrees of enhancement of intestinal tube and enlargement at the lesion site under "aneurysmal" enhancement scan.There were 3 cases of polypoid mass type,and the soft tissue mass shadow of polypoid was seen under CT,and the shape was relatively regular and lobulated.The morphology of the lesion was regular or lobulated on enhanced scan,and mild enhancement was observed on enhanced scan.2 cases of mesenteric infiltration,the mesentery was thickened and the density of fat space was increased under CT.All the 20 patients completed the surgical treatment,including the time of first exhaust and defecation(23.51±4.52)h,time of first meal(13.27±2.31)h,time of relief of abdominal pain and abdominal distension(14.69±3.21)h,time of hospitalization(12.14±3.42)days. Conclusion The use of computed tomography in patients with primary small intestinal malignant lymphoma can help patients diagnose early and improve postoperative gastrointestinal function,which is worthy of promotion and application.
引文
[1]房娜,王艳丽,曾磊,等.18F-FDGPET/CT显像在原发性小肠淋巴瘤中的应用[J].中华核医学与分子影像杂志,2015,35(2):147-148.
[2]宋双双,于澜,周晓明,等.原发性肠道T细胞淋巴瘤CT小肠造影的影像特点及其诊断价值[J].中国医学影像技术,2017,33(7):1010-1013.
[3]Carbonnel F,Lavergne A,Messing B,et al.Extensive small intestinal T-cell lymphoma of low-grade malignancy associated with a new chromosomal translocation[J].Cancer,2015,73(4):1286-1291.
[4]杨创勃,李新胜,任成龙,等.能谱CT在鉴别小肠腺癌和原发小肠淋巴瘤中的临床价值[J].中国医学影像学杂志,2016,24(11):834-838.
[5]李坚,黄楠,肖泽彬,等.小肠淋巴瘤的CT和MRI表现[J].临床放射学杂志,2015,34(11):1784-1789.
[6]关炜,王全师,吴湖炳,等.原发性肠淋巴瘤的-(18)F-FDGPET/CT影像学表现[J].南方医科大学学报,2016,36(9):1175-1180.
[7]Lee YT,Liu CJ,Hu YW,et al.Incidence of Second Primary Malignancies Following Colorectal Cancer:A distinct pattern of occurrence between colon and rectal cancers and association of co-morbidity with second primary malignancies in a population-based cohort of 98,876 Patients in Taiw[J].Medicine,2015,94(26):e1079.
[8]杨朝武,何光武,李征宇,等.原发性胃肠道淋巴瘤64排螺旋CT/MRI影像特点分析[J].中国临床医学影像杂志,2015,26(1):23-26.
[9]周峻,陈芳林,王浩,等.肠套叠为首发表现儿童原发性胃肠道淋巴瘤临床特征分析[J].中华肿瘤防治杂志,2015,22(19):1561-1565.
[10]刘静,焦俊,张英俊,等.小肠肠壁增厚的多层螺旋CT小肠造影征象分析和诊断价值[J].临床放射学杂志,2015,34(12):1919-1923.
[11]李少玲,付骞千,张甜甜,等.原发性胃肠道非霍奇金淋巴瘤的临床特征及预后因素分析[J].肿瘤防治研究,2017,44(1):28-33.
[12]Schapiro AH,Lin TK,Frischer JS,et al.Extensive heterotopic gastric mucosa of the small intestine:imaging with(99m)Tc-sodiumpertechnetateSPECT/CT enterography[J].Pediatric Radiology,2016,46(13):1873-1878.
[13]陈海珠,宋腾,张会来,等.原发性胃肠道弥漫大B细胞淋巴瘤195例的临床特征和预后分析[J].中华消化杂志,2016,36(8):519-525.
[14]夏朝霞,方建晨,汪春年,等.原发肠道NK/T细胞淋巴瘤10例临床病理分析[J].临床与实验病理学杂志,2016,32(2):170-174.
[15]付远志,刘振翠.原发性小肠腺癌与小肠淋巴瘤的多层螺旋CT表现及鉴别诊断[J].中国医药导报,2016,13(1):110-112.
[2]宋双双,于澜,周晓明,等.原发性肠道T细胞淋巴瘤CT小肠造影的影像特点及其诊断价值[J].中国医学影像技术,2017,33(7):1010-1013.
[3]Carbonnel F,Lavergne A,Messing B,et al.Extensive small intestinal T-cell lymphoma of low-grade malignancy associated with a new chromosomal translocation[J].Cancer,2015,73(4):1286-1291.
[4]杨创勃,李新胜,任成龙,等.能谱CT在鉴别小肠腺癌和原发小肠淋巴瘤中的临床价值[J].中国医学影像学杂志,2016,24(11):834-838.
[5]李坚,黄楠,肖泽彬,等.小肠淋巴瘤的CT和MRI表现[J].临床放射学杂志,2015,34(11):1784-1789.
[6]关炜,王全师,吴湖炳,等.原发性肠淋巴瘤的-(18)F-FDGPET/CT影像学表现[J].南方医科大学学报,2016,36(9):1175-1180.
[7]Lee YT,Liu CJ,Hu YW,et al.Incidence of Second Primary Malignancies Following Colorectal Cancer:A distinct pattern of occurrence between colon and rectal cancers and association of co-morbidity with second primary malignancies in a population-based cohort of 98,876 Patients in Taiw[J].Medicine,2015,94(26):e1079.
[8]杨朝武,何光武,李征宇,等.原发性胃肠道淋巴瘤64排螺旋CT/MRI影像特点分析[J].中国临床医学影像杂志,2015,26(1):23-26.
[9]周峻,陈芳林,王浩,等.肠套叠为首发表现儿童原发性胃肠道淋巴瘤临床特征分析[J].中华肿瘤防治杂志,2015,22(19):1561-1565.
[10]刘静,焦俊,张英俊,等.小肠肠壁增厚的多层螺旋CT小肠造影征象分析和诊断价值[J].临床放射学杂志,2015,34(12):1919-1923.
[11]李少玲,付骞千,张甜甜,等.原发性胃肠道非霍奇金淋巴瘤的临床特征及预后因素分析[J].肿瘤防治研究,2017,44(1):28-33.
[12]Schapiro AH,Lin TK,Frischer JS,et al.Extensive heterotopic gastric mucosa of the small intestine:imaging with(99m)Tc-sodiumpertechnetateSPECT/CT enterography[J].Pediatric Radiology,2016,46(13):1873-1878.
[13]陈海珠,宋腾,张会来,等.原发性胃肠道弥漫大B细胞淋巴瘤195例的临床特征和预后分析[J].中华消化杂志,2016,36(8):519-525.
[14]夏朝霞,方建晨,汪春年,等.原发肠道NK/T细胞淋巴瘤10例临床病理分析[J].临床与实验病理学杂志,2016,32(2):170-174.
[15]付远志,刘振翠.原发性小肠腺癌与小肠淋巴瘤的多层螺旋CT表现及鉴别诊断[J].中国医药导报,2016,13(1):110-112.