个体化及缓和医疗用于90岁胃原发弥漫性大B细胞淋巴瘤患者：4年随访结果及启示

doi:10.24920/003682

摘要/Abstract

摘要：

本文报道一名90岁患者于2016年4月年度例行体检时,通过PET/CT、胃镜和病理+免疫组化确诊胃原发性弥漫性大B细胞淋巴瘤。患者接受了利妥昔单抗、环磷酰胺、长春新碱（R-CO）化疗以及后续的放疗。之后患者发生幽门梗阻,遂放置三腔鼻-胃肠管给予肠内营养。为了满足患者经口进食的强烈愿望,我们进行了剖腹探查和胃-空肠吻合术（RGB）以解除幽门梗阻。术后患者恢复了经口进食,并辅以鼻饲饮食,每日热量1350-1550 Kcal。患者目前94岁,营养状态中等,认知正常。本例4年诊疗及随访结果提示,除了有效的化疗、放疗以及外科手术治疗之外,营养照护和缓和医疗对改善超高龄晚期肿瘤患者的预后及生活质量也非常重要。

关键词: 胃原发肿瘤, 弥漫性大B细胞淋巴瘤, 超高龄, 营养支持, 缓和医疗

Abstract:

A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma (PGDLBL) by PET/CT examination, gastroscopy, biopsy and histopathological analysis at a regular physical check in April, 2016. The patient received R-CO chemotherapy (rituximab, cyclophosphamide, and vincristine) and radiotherapy subsequently, with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction. To satisfy patient’s strong desire of eating by himself, we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass (RGB) to relieve pylorus obstruction. Postoperatively, the patient resumed oral feeding, supplemented by nasogastric tube feeding at 1350 - 1550 Kcal daily. He is now 94 years old with fairly well nutrition and normal communication. The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy, radiotherapy, and surgery.

Key words: primary gastric lymphoma, diffuse large B-cell lymphoma, very elderly patient, nutritional treatment, palliative care

基金资助: 军委后勤保障部保健专项课题(18BJZ07)

Yanjie Cao,Jingqi Duan,Lifang Liu,Xuan Wei,Li Ren,Lanning Zhang,Wei Zhang. Individualized Treatment and Palliative Care for A 90-Year-Old Patient with Primary Gastric Diffuse Large-B Cell Lymphoma: 4 Year Follow-up and Inspiration[J].Chinese Medical Sciences Journal, 2021, 36(1): 72-77.

图/表 3

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Laboratory indexes	On admission (2016.4)	Pylorus obstruction (2016.9)	Current (2020.4)
Weight (kg)	94	70	75
BMI (kg/m²)	31.4	23.4	25.1
Red blood cells(×10¹²/L)	2.7	2.7	2.6
Fecal occult blood testing	+	±	-
Hemoglobin (g/dL)	8.4	9.0	9.4
Serum creatinine (μmol/L)	126	123	102
eGFR (mL/min·1.73m²)	49.6	51.1	62.8
Alanine aminotransferase (U/L)	9	10	9
Aspartate aminotransaminase (U/L)	22	19	21
Total protein(g/L)	55.5	49.5	54.9
Pre-albumin (mg/L)	248	193	188
Albumin (g/L)	36.5	32.4	36.2
Total cholesterol(mmol/L)	4.6	3.0	3.7
Low density lipoprotein (mmol/L)	3.2	1.9	2.6
Triglycerides (mmol/L)	0.9	1.3	1.4

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