Spectre Galia, Libster Diana, Grisariu Sigal, Da'as Nael, Yehuda Dina Ben, Gimmon Zvi, Paltiel Ora
Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120.
Ann Surg Oncol. 2006 Nov;13(11):1372-8. doi: 10.1245/s10434-006-9069-x. Epub 2006 Sep 30.
The management of patients with gastric lymphoma has evolved, with a shift toward nonsurgical treatment. The rates of surgical complications in patients receiving chemotherapy have been insufficiently studied. The objective of this study was to assess the frequency of bleeding, perforation, and gastric outlet obstruction in patients who received chemotherapy as primary treatment for gastric diffuse large B cell lymphoma (DLBCL).
We reviewed files of all patients with gastric DLBCL who were diagnosed and treated primarily with chemotherapy in our hospital between 1990 and 2005.
Eighteen (25%) of 73 patients experienced surgical complications, of whom 6 (8%) underwent surgery. Eight patients (11%), six with active lymphoma, experienced gastric bleeding; one required gastrectomy. Eight patients (11%) developed gastric outlet obstruction, of whom three were treated conservatively, three required surgery, one stopped treatment, and one received further chemotherapy. Six of the eight patients had no evidence of active lymphoma at the time of obstruction. Two additional patients underwent gastrectomy due to resistant or relapsed disease. Gastric perforation was not observed. Median survival was 90 months for the entire series, 94 months for patients with gastric outlet obstruction, and 11.5 months for patients with gastric bleeding.
Given the rate of surgical complications, especially gastric bleeding and gastric outlet obstruction, there is still an important role for the surgical consultant in the treatment of patients with gastric DLBCL receiving chemotherapy. Gastric perforation, although frequently cited as a complication, is in fact rarely observed.
胃淋巴瘤患者的治疗方法已经有所发展，正朝着非手术治疗方向转变。接受化疗患者的手术并发症发生率尚未得到充分研究。本研究的目的是评估接受化疗作为胃弥漫性大B细胞淋巴瘤（DLBCL）主要治疗方法的患者发生出血、穿孔和胃出口梗阻的频率。
我们回顾了1990年至2005年间在我院主要接受化疗诊断和治疗的所有胃DLBCL患者的病历。
73例患者中有18例（25%）发生手术并发症，其中6例（8%）接受了手术。8例患者（11%）出现胃出血，其中6例患有活动性淋巴瘤；1例需要进行胃切除术。8例患者（11%）发生胃出口梗阻，其中3例接受保守治疗，3例需要手术，1例停止治疗，1例接受进一步化疗。8例患者中有6例在梗阻时没有活动性淋巴瘤的证据。另外2例患者因疾病耐药或复发接受了胃切除术。未观察到胃穿孔。整个系列的中位生存期为90个月，胃出口梗阻患者为94个月，胃出血患者为11.5个月。
鉴于手术并发症的发生率，尤其是胃出血和胃出口梗阻，手术顾问在接受化疗的胃DLBCL患者的治疗中仍发挥着重要作用。胃穿孔虽然经常被列为并发症，但实际上很少观察到。
