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目的 :分析胃黏膜相关恶性淋巴瘤的术前诊断、外科治疗及术中对瘤灶的探查、确诊的经验。方法 :1995年～ 2 0 0 1年 6月手术治疗的 6例病人中 ,ⅠE期 4例 ,ⅡE期 2例。 5例胃镜检查并 4例行镜下活检 ,2例术中活检 ;1例行胃大部切除 ,余 5例行胃癌D2 手术。术后辅助化疗 3例。结果 :术前、术中活检分别确诊 2例和 1例 ,3例未能确诊者 ,术中 2例按临床诊断行根治切除 ;1例当成良性溃疡切除。 6例均经病理证实。术后随访 7个月～ 4年 ,1例术后 5个月死于左肺瘤转移 ,其余均存活。结论 :胃黏膜相关恶性淋巴瘤在术前、术中活检确诊率都较低 ,术中活检很有必要 ;对术中活检仍未明确的 ,可依临床诊断决定根治方案。术中注意不要遗漏多发病灶 ,在其粘膜、浆膜面之间进行“双合诊” ,是发现小瘤灶的一个有效方法。
Objective: To analyze the preoperative diagnosis, surgical treatment and intraoperative exploration of tumor focus and diagnosis of gastric mucosa-associated malignant lymphoma. Methods: Of the 6 patients who underwent surgery between June 1995 and June 2001, 4 cases were stage ⅠE and 2 cases were stage ⅡE. 5 cases of gastroscopy and 4 cases of biopsy, biopsy in 2 cases; 1 case of subtotal gastrectomy, more than 5 cases of gastric cancer D2 surgery. Postoperative adjuvant chemotherapy in 3 cases. Results: Preoperative and intraoperative biopsy were confirmed in 2 cases and 1 case, 3 cases were not diagnosed, 2 cases underwent radical resection by clinical diagnosis and 1 case as benign ulcer. 6 cases were confirmed by pathology. The patients were followed up for 7 months to 4 years. One patient died of left lung tumor metastasis 5 months after operation, and the rest survived. Conclusions: The biopsy rates of gastric mucosa-associated malignant lymphoma before surgery and during surgery are low, and intraoperative biopsy is necessary. For biopsy of the patients with gastric mucosa-associated malignant lymphoma which is still not clear, the radical diagnosis can be decided according to clinical diagnosis. Note that surgery should not miss multiple lesions in its mucosa, serosa surface between the “double joint diagnosis”, is to find an effective method of small tumor.