中国实用外科杂志

中国实用外科杂志 ›› 2021, Vol. 41 ›› Issue (10): 1164-1167.DOI: 10.19538/j.cjps.issn1005-2208.2021.10.12

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胃肠道淋巴瘤并发急性穿孔36例临床病理特征及预后因素分析

束    平，吴健章，陈    昊，方    勇， 刘凤林   

  1. 复旦大学附属中山医院普外科，上海200032
  • 出版日期:2021-10-01 发布日期:2021-10-19

  • Online:2021-10-01 Published:2021-10-19

摘要： 目的    探讨胃肠道淋巴瘤并发急性穿孔的临床病理特征及预后影像因素。方法    回顾性分析2013年1月至2020年12月复旦大学附属中山医院收治的因胃肠道淋巴瘤并发急性穿孔行急诊手术的36例病人的临床资料。分析其临床病理特征、术后死亡情况以及死亡相关风险因素。结果    36例病人中32例（88.9%）为小肠淋巴瘤穿孔。所有病人均为非霍奇金淋巴瘤，且以侵袭性病理类型多见，其中单形性嗜上皮性肠道T细胞淋巴瘤［44.4%（16/36）］和弥漫性大B细胞淋巴瘤［33.3%（12/36）］为最常见的两种病理亚型。术后共11例病人（30.6%，11/36）发生死亡，其中10例为术后即转入重症监护室（ICU）的病人。在转入ICU的29例重症病人中，发生死亡者术后动脉血乳酸水平（P=0.006）及序贯器官衰竭（SOFA）评分（P=0.016）均高于生存者，而其他指标差异均无统计学意义（P>0.05）。结论    淋巴瘤引起的消化道急性穿孔多发生于小肠，术后病死率高；较高的SOFA评分及动脉血乳酸水平可能是死亡相关危险因素。

关键词: 胃肠道淋巴瘤, 穿孔, 急诊手术

Abstract: Clinicopathological characteristic and prognosis of gastrointestinal lymphoma patients complicated with acute perforation                SHU Ping，WU Jian-zhang，CHEN Hao，et al. Department of General Surgery，Zhongshan Hospital，Fudan University，Shanghai 200032，China
Corresponding author：LIU Feng-lin，E-mail：liu.fenglin@zs-hospital.sh.cn
Abstract    Objective    To investigate the clinicopathological characteristics and surgical outcomes of patients with gastrointestinal lymphoma complicated by acute perforation. Methods    The clinical data of 36 gastrointestinal lymphoma patients with acute perforation were collected in the Zhongshan Hospital of Fudan University from January 2013 to December 2020. A retrospective analysis was conducted on clinicopathological characteristics, postoperative deaths and related risk factors. Results    Of the 36 patients, 32 (88.9%) were small bowel lymphoma perforation. All patients were non-Hodgkin's lymphoma cases commonly with invasive pathology, of which monomorphic epithelial intestinal T-cell lymphoma ［44.4% (16/36)］ and diffuse large B-cell lymphoma ［33.3% (12/36)］ were the two most common subtypes. A total of 11 patients (30.6%, 11/36) died after surgery, of which 10 died of 29 patients who were transferred to ICU immediately after surgery. Among the severely ill patients transferred to ICU, the postoperative arterial blood lactate level (P=0.006) and SOFA score (P=0.016) of those who died were higher than those of survivors, but there was no statistical difference in other indicators. Conclusion    Acute perforation of the gastrointestinal lymphoma mostly occurs in the small intestine and the mortality is high even after surgery. Higher SOFA scores and arterial blood lactic acid levels may be  risk factors related to death.

Key words: gastrointestinal lymphoma, perforation, emergency operation, prognosis