Wakiya Taiichi, Shibata Shigeru, Sutou Takemichi, Narita Junichi, Iino Chikara, Sakamoto Juichi, Yamanaka Yuji
1Dept. of Surgery, Hirosaki Municipal Hospital.
Gan To Kagaku Ryoho. 2014 Nov;41(12):2453-5.
Perforation, bleeding, and ileus are known complications of small intestinal lymphoma and can occur either at diagnosis or during the course of treatment. Surgery is an important component in the management of these gastrointestinal complications. However, there is no consensus regarding the indications for and timing of surgery in small intestinal lymphoma. We herein present our experience with a case of small intestinal lymphoma with ileus that required surgery during chemotherapy. A 69-year-old man developed abdominal pain. Computed tomography revealed lower right jaw lymphadenopathy, small intestinal wall thickening, and mesenteric lymphadenopathy. Malignant lymphoma (diffuse large B-cell type) was diagnosed on the basis of a lower jaw lymph node biopsy. The patient was initially administered chemotherapy. After the third cycle of chemotherapy, the patient developed small intestinal obstruction detected upon abdominal computed tomography. Because a stricture persisted despite medical treatment, we performed partial resection of the small intestine. The postoperative course was good, and the patient rapidly resumed chemotherapy. Currently, 6 months after the surgery, the patient is alive without any progression of the lymphoma. A multidisciplinary treatment strategy, including surgery, is desirable to achieve a safe but radical cure for small intestinal lymphoma.
穿孔、出血和肠梗阻是小肠淋巴瘤已知的并发症，可在诊断时或治疗过程中发生。手术是这些胃肠道并发症管理的重要组成部分。然而，关于小肠淋巴瘤手术的指征和时机尚无共识。我们在此介绍一例小肠淋巴瘤伴肠梗阻患者在化疗期间需要手术的经验。一名69岁男性出现腹痛。计算机断层扫描显示右下颔淋巴结肿大、小肠壁增厚和肠系膜淋巴结肿大。根据下颔淋巴结活检诊断为恶性淋巴瘤（弥漫大B细胞型）。患者最初接受化疗。化疗第三个周期后，腹部计算机断层扫描发现患者出现小肠梗阻。尽管进行了药物治疗，但狭窄仍持续存在，因此我们对小肠进行了部分切除。术后过程顺利，患者迅速恢复化疗。目前，手术后6个月，患者存活，淋巴瘤无任何进展。包括手术在内的多学科治疗策略对于实现小肠淋巴瘤安全但根治性的治疗是可取的。
