članak: 1 od 1  
Acta chirurgica iugoslavica
2007, vol. 54, br. 1, str. 131-134
jezik rada: srpski
stručni članak
doi:10.2298/ACI0701131V

Krvarenje iz gornjih partija digestivnog trakta kao hirurška komplikacija primarnog limfoma želuca
Univerzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije

Sažetak

Primarni limfom želuca spada u grupu ekstranodalnih non-Hodgkin limfoma. Ekstranodalni limfomi u 30-45% slučajeva nastaju u gastrointestinalnom traktu. Među gastrointestinalnim limfomima limfom želuca je najčešći i čini 55-70% svih slučajeva. Primarni limfom želuca je relativno redak tumor i čini 1-7% svih malignih tumora želuca. Novije epidemiološke studije ukazuju da je njegova incidenca u porastu. Najčešće se javlja u šestoj deceniji života, gotovo podjednako kod muškaraca i žena. Simptomi su često nespecifični, što dovodi do zakašnjenja u postavljanju dijagnoze i početka lečenja čak i nekoliko godina. Zbog toga se veliki broj pacijenata javlja u fazi uznapredovale bolesti, često sa već prisutnim komplikacijama, od kojih je najčešće krvarenje. Okultno ili manifestno krvarenje u formi hematemeze i melene se javlja kod čak 20-30% pacijenata. Osim kao inicijalni simptom, akutno krvarenje iz limfoma može nastati i kao komplikacija hemioterapije. Incidenca ovih krvarenja iznosi i do 11%. U najvećem broju slučajeva akutnog krvarenja konzervativno lečenje je neuspešno, te je indikovana hirurška intervencija u cilju postizanja hemostaze. Zbog moguće pojave ozbiljnih hirurških komplikacija tokom konzervativnog lečenja primarnog limfoma želuca (krvarenje, stenoza, perforacija) hirurško lečenje i dalje predstavlja nezaobilazni deo multidisciplinarnog pristupa u lečenju ovih pacijenata.

Ključne reči

Reference

Al-Akwaa, A.M., Siddiqui, N., Al-Mofleh, I.A. (2004) Primary gastric lymphoma. World J Gastroenterol, 10(1): 5-11
Aviles, A., Nambo, J.M., Neri, N., Huerta-Guzman, J., Cuadra, I., Alvarado, I., Castaneda, C., Fernandez, R., Gonzalez, M. (2004) The role of surgery in primary gastric lymphoma: Results of a controlled clinical trial. Ann Surg, 240(1): 44-50
Dawson, I.M., Cornes, J.S., Morson, B.C. (1961) Primary malignant lymphoid tumours of the intestinal tract: Report of 37 cases with a study of factors influencing prognosis. Br J Surg, 49 80-9
Freeman, C., Berg, J.W., Cutler, S.J. (1972) Occurrence and prognosis of extranodal lymphomas. Cancer, 29(1): 252-60
Haim, N., Leviov, M., Ben-Arieh, Y., Epelbaum, R., Freidin, N., Reshef, R., Ben-Shahar, M. (1995) Intermediate and high-grade gastric non-Hodgkin's lymphoma: A prospective study of non-surgical treatment with primary chemotherapy, with or without radiotherapy. Leuk Lymphoma, 17(3-4): 321-6
Haq, A., Khan, A., Modlin, I.M., Rosin, R.D. (2006) Surgery for upper gastrointestinal bleeding. u: From Gastrin to GERD, A Century of Acid Suppression. Felsenstein C.C.C.P., str. 382-411
Hatfield, A.R., Slavin, G., Segal, A.W., Levi, A.J. (1975) Importance of the site of endoscopic gastric biopsy in ulcerating lesions of the stomach. Gut, 16(11): 884-6
Hsu, C., Chen, C.L., Chen, L.T., Liu, H.T., Chen, Y.C., Jan, C.M., Liu, C.S., Cheng, A.L. (2001) Comparison of MALT and non-MALT primary large cell lymphoma of the stomach: Does histologic evidence of MALT affect chemotherapy response?. Cancer, 91(1): 49-56
Kelessis, N.G., Vassilopoulos, P.P., Tsamakidis, K.G., Bai, M.G., Avital, S., Rosenthal, R.J. (2003) Is gastroscopy still a valid diagnostic tool in detecting gastric MALT lymphomas? A dilemma beyond the eye. Mucosa-associated lymphoid tissue. Surg Endosc, 17(3): 469-74
Kong, S., Kim, M.A., Park, D., Lee, H., Lee, H., Kim, C., Yang, H., Heo, D., Lee, K., Choe, K. (2004) Clinicopathologic features of surgically resected primary gastric lymphoma. World J Gastroenterol, 10(8): 1103-9
Lin, H.J., Lee, F.Y., Tsai, Y.T., Lee, S.D., Lin, C.Y., Tsay, S.H., Chiang, H. (1989) A prospective evaluation of biopsy site in the diagnosis of gastric malignancy: The margin or the base?. J Gastroenterol Hepatol, 4(2): 137-41
Nishimura, H., Saito, M., Shibata, K., Ueno, K., Maeura, Y., Murata, A. (1989) A case of malignant lymphoma accompanied with arterial bleeding from the gastric lesion. Jpn J Med, 28(5): 604-7
Nomura, K., Yamada, S., Shimizu, D., Okuda, T., Kamitsuji, Y., Yoshida, N., Matsumoto, Y., Wakabayashi, N., Mikami, K., Horiike, S., Okanoue, T., Taniwaki, M. (2005) Successful endoscopic hemostasis for gastric arterial bleeding due to invasion of malignant lymphoma. World J Gastroenterol, 11(27): 4285-6
Park, Y.H., Lee, S., Kim, W.S., Bang, S., Ryoo, B., Yang, S.H., Lee, S., Kim, M.S., Kim, K., Park, K.W., Im, D.H., Kang, J.H., Lee, J., Ko, Y.H., Ahn, Y.C., Lim, D.H., Park, K. (2006) CHOP followed by involved field radiotherapy for localized primary gastric diffuse large B-cell lymphoma: Results of a multi center phase II study and quality of life evaluation. Leukemia and Lymphoma, 47(7), 1253-1259
Peško, P., Ranđelović, T., Knežević, J., Dunjić, M., Radovanović, N., Bjelović, M., Stojakov, D., Sabljak, P., Kotarac, M., Simić, A., Kostić, D., Micev, M. (2000) Hirurška strategija u lečenju primarnog limfoma želuca. Acta chirurgica iugoslavica, vol. 47, br. 3, str. 33-35
Rackner, V.L., Thirlby, R.C., Ryan, J.A. (1991) Role of surgery in multimodality therapy for gastrointestinal lymphoma. Am J Surg, 161(5): 570-5
Sandler, R.S. (1984) Has primary gastric lymphoma become more common?. J Clin Gastroenterol, 6(2): 101-7
Spectre, G., Libster, D., Grisariu, S., da N., Yehuda, D.B., Gimmon, Z., i dr. (2006) Bleeding, obstruction, and perforation in a series of patients with aggressive gastric lymphoma treated with primary chemotherapy. Annals of Surgical Oncology, 13(11): 1372
Starostik, P., Patzner, J., Greiner, A., Schwarz, S., Kalla, J., Ott, G., Muller-Hermelink, H.K. (2002) Gastric marginal zone B-cell lymphomas of MALT type develop along 2 distinct pathogenetic pathways. Blood, 99(1): 3-9
Yoon, S.S., Coit, D.G., Portlock, C.S., Karpeh, M.S. (2004) The diminishing role of surgery in the treatment of gastric lymphoma. Ann Surg, 240(1): 28-37
Zucca, E., Bertoni, F., Roggero, E., Cavalli, F. (2000) The gastric marginal zone B-cell lymphoma of MALT type. Blood, 96(2): 410-9