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目的探讨原发性中枢神经系统淋巴瘤(PCNSL)的临床特点,提高对 PCNSL 的认识。方法回顾性分析43例 PCNSL 患者的临床表现、实验室检查、影像学特点、组织病理类型以及治疗方法。结果单发病灶36例,多发病灶7例,共手术治疗47次。首发症状为颅内压增高22例(51.2%),肢体偏瘫、抽搐、语言障碍16例(37.2%),记忆力下降、意识情感障碍10例(23.3%)。脑脊液蛋白含量高于正常者66.7%(8/12)。B 细胞型淋巴瘤40例(97.6%),T 细胞型1例(2.4%)。Ki-67阳性表达指数42.8%±23.3%。结论 CT、MRI 及脑脊液检查是术前诊断 PCNSL 的重要方法,外周血淋巴细胞增高不能作为诊断 PCNSL 的依据。手术在于缓解症状和确定病变的病理类型,术后化疗加全脑放疗是治疗 PCNSL 的有效方法。
Objective To investigate the clinical features of primary central nervous system lymphoma (PCNSL) and to improve the understanding of PCNSL. Methods Retrospective analysis of 43 cases of PCNSL patients with clinical manifestations, laboratory tests, imaging features, histopathological types and treatment methods. Results Single lesions in 36 cases, multiple lesions in 7 cases, a total of 47 surgical treatment. The first symptom was intracranial pressure increased in 22 cases (51.2%), limb hemiplegia, convulsions, speech disorders in 16 cases (37.2%), memory loss, disturbance of consciousness in 10 cases (23.3%). Cerebrospinal fluid protein content was 66.7% (8/12) higher than normal. 40 cases of B cell lymphoma (97.6%), 1 case of T cell (2.4%). Ki-67 positive expression index 42.8% ± 23.3%. Conclusion CT, MRI and cerebrospinal fluid are important methods for preoperative diagnosis of PCNSL. Increased peripheral blood lymphocytes can not be used as a basis for diagnosis of PCNSL. Surgery is to relieve symptoms and determine the pathological type of lesions, postoperative chemotherapy plus whole brain radiotherapy is an effective method of treatment of PCNSL.