大肠黏膜相关淋巴组织淋巴瘤的临床特征及内镜诊治价值

Clinical characteristics and endoscopic diagnosis and treatment for colorectal mucosa associated lymphoid tissue lymphoma

摘要:

本研究对2015年1月—2021年6月在江苏省中医院消化内镜中心诊治的6例大肠黏膜相关淋巴组织（mucosa associated lymphoid tissue，MALT）淋巴瘤病例进行了回顾性观察，结果显示：男2例、女4例，年龄62～87岁，病变位于直肠3例、横结肠1例、乙状结肠1例、乙状结肠+直肠1例，息肉病型1例、炎症型2例、黏膜下隆起型3例，表面呈“树枝样外观”5例；2例行内镜下切除、1例行外科手术联合化疗、1例行幽门螺旋杆菌根除治疗、2例因个人原因选择随访，1例失访，其余5例随访21～73个月均预后良好，内镜及影像学复查均未见复发。提示对肠镜检查中发现位于左半结肠的黏膜下隆起型病灶，表面呈“树枝样外观”时，应考虑到大肠MALT淋巴瘤的可能性，在早期诊断的前提下，内镜下切除治疗有成为一线治疗方案的潜力。

Abstract:

Clinical and endoscopic data of 6 patients with colorectal mucosa associated lymphoid tissue (MALT) lymphoma who were diagnosed by endoscopy in the Digestive Endoscopy Center of Jiangsu Province Hospital of Chinese Medicine from January 2015 to June 2021 were retrospectively analyzed. There were 2 males and 4 females with aged from 62 to 87 years. The lesions were located in rectum in 3 cases, transverse colon in 1 case, sigmoid colon in 1 case, and sigmoid colon and rectum in 1 case. There were 1 case of polyposis type, 2 cases of inflammation type, and 3 cases of submucosal tumor type. The "tree‑like appearance (TLA)" found in 5 cases. Endoscopic resection, surgery combined with chemotherapy, Helicobacter pylori eradication and follow‑up were performed on 2, 1, 1 and 2 cases, respectively. Five cases had a good prognosis after 21⁃73 months follow⁃up, and 1 case had lost to follow⁃up. No recurrence was found in endoscopic and imaging review. Colorectal MALT lymphoma should be considered when colonoscopy detects a submucosal lesion with TLA sign on the left colon. Endoscopic resection has the potential to be a first⁃line treatment in the context of early diagnosis.