2023 年第 6 期 第 18 卷

恶性淋巴水肿患者临床特征分析

Analysis of clinical characteristics of patients with malignant lymphedema

作者：郝昆1孙宇光1李滨2信建峰1张丽3余春开4王仁贵5沈文彬1

英文作者：Hao Kun1 Sun Yuguang1 Li Bin2 Xin Jianfeng1 Zhang Li3 Yu Chunkai4 Wang Rengui5 Shen Wenbin1

单位：1首都医科大学附属北京世纪坛医院淋巴外科，北京100038；2首都医科大学附属北京世纪坛医院磁共振室，北京100038；3首都医科大学附属北京世纪坛医院核医学科，北京100038；4首都医科大学附属北京世纪坛医院病理科，北京100038；5首都医科大学附属北京世纪坛医院放射科，北京100038

英文单位：1Department of Lymphatic Surgery Beijing Shijitan Hospital Capital Medical University Beijing 100038 China; 2Magnetic Resonance Imaging Room Beijing Shijitan Hospital Capital Medical University Beijing 100038 China; 3Department of Nuclear Medicine Beijing Shijitan Hospital Capital Medical University Beijing 100038 China; 4Department of Pathology Beijing Shijitan Hospital Capital Medical University Beijing 100038 China; 5Department of Radiology Beijing Shijitan Hospital Capital Medical University Beijing 100038 China

关键词：淋巴水肿；恶性肿瘤；临床特征

英文关键词：Lymphedema;Malignanttumor;Clinicalcharacteristics

• 摘要：

• 目的  分析恶性淋巴水肿患者的临床特征，为恶性淋巴水肿的临床诊治提供参考。方法  回顾性分析首都医科大学附属北京世纪坛医院2007年5月至2018年12月确诊为恶性淋巴水肿的115例患者的临床及病理资料。结果  恶性淋巴水肿患者常伴有淋巴结肿大、发现肿物、肢体运动障碍、感觉异常、疼痛等临床表现。贫血患者的比例为27.8%（32/115），其中轻度贫血24.3%(28/115)，中度贫血3.5%(4/115)；肿瘤标志物异常的患者比例为57.0%（53/93）。对可疑患者进行影像学检查，其中超声检查的阳性率为37.9%（22/58）、CT检查的阳性率为59.7%（46/77）、磁共振成像（MRI）检查的阳性率为75.0%（24/32）、放射性核素显像的阳性率为31.2%（24/77）。82例患者留取84个组织标本做病理诊断，其中肿瘤来源于上皮组织48例、来源于间叶组织23例、来源于淋巴造血组织13例。不同年龄分组患者淋巴水肿临床特征差异无统计学意义（P>0.05）。病程>2年组患者肿瘤标志物异常比例低于病程≤2年组，差异有统计学意义（P<0.05）。结论  恶性淋巴水肿患者以肢体肿胀为主诉，常伴有多种临床症状，肿瘤标志物、超声、CT、MRI和放射性核素显像是诊断的有效方法。

• Objective    To analyze the clinical characteristics of patients with malignant lymphedema and to provide references for clinical diagnosis and treatment of malignant lymphedema. Methods  From May 2007 to December 2018, retrospective analysis was made on the clinical and pathological data of 115 patients with malignant lymphedema diagnosed in Beijing Shijitan Hospital, Capital Medical University. Results  Patients with malignant lymphedema were often accompanied by clinical feature such as lymph node enlargement, tumor discovery, limb movement disorder, paresthesia, pain and so on. The proportion of anemia was 27.8%(32/115), including 24.3%(28/115) of mild anemia and 3.5%(4/115) of moderate anemia. The proportion of patients with abnormal tumor markers was 57.0%(53/93). Imaging examination was carried out for suspected patients. The positive rate of ultrasound examination was 37.9%(22/58), the positive rate of CT was 59.7%(46/77), the positive rate of magnetic resonance imaging(MRI) was 75.0%(24/32), and the positive rate of radionuclide imaging was 31.2%(24/77). There were 84 tissue samples taken from 82 patients for pathological diagnosis, including 48 tumors from epithelial tissue, 23 tumors from mesenchymal tissue and 13 tumors from lymphohematopoietic tissue. There was no significant difference in the clinical characteristics of lymphedema among different age groups(P>0.05). The proportion of abnormal tumor markers in the group with the course of disease >2 years was lower than that in the group with the course of disease ≤2 years(P<0.05). Conclusions  Malignant lymphedema patients mainly complain about limb swelling, and accompany by a variety of clinical symptoms. Tumor markers, ultrasound, CT, MRI and radionuclide imaging are effective methods for diagnosis.