tailieunhanh - Upper Gastrointestinal Surgery - part 7

Hình 17,1. Tiền xử lý siêu âm nội soi hình ảnh hiển thị MALT (A) thấp cấp MALT lymphoma hạn chế để niêm mạc không có cuộc xâm lược submucosal quan trọng, (B) một MALT lymphoma cao cấp với một thành phần cấp thấp xâm nhập các lọ thuốc sâu sắc hơn về các submucosa | 236 17 UPPER GASTROINTESTINAL SURGERY figure . Pretreatment endoscopic ultrasound images of MALT showing A a low grade MALT lymphoma restricted to the mucosa with no significant submucosal invasion B a high grade MALT lymphoma with a low grade component invading the deeper potion of the submucosa C a high grade MALT lymphoma with a low grade component invading the muscularis propria and D a high grade MALT lymphoma with a low grade component involving the serosa. Reproduced from Nakamura S Matsumoto T Suekane H et al Predictive value of endoscopic ultrasonography for regression of grastric low grade and high grade MALT lymphomas after eradication of Helicobacter pylori M. Gut 2001 48 454-60 with permission from the BMJ Publishing Group. Features of Those Less Likely to Respond to H. pylori Eradication Involvement beyond the submucosa Evidence of nodal involvement Patients with chromosome 11-18 translocations Outcomes Once eradication therapy has been commenced there are a series of possible outcomes on follow-up. Early stage disease stage I IIj reviewed at 3 months after completion of eradication therapy may show 1. H. pylori negative and regression of the lymphoma when observation can be repeated in 3 months. 2. H. pylori negative and lymphoma present. In the absence of symptoms observation for a further 3 months may allow regression but if symptomatic most would give radiotherapy or possibly single agent chemotherapy most usually chlorambucil . Clinical judgement is required to determine how long observation can proceed to allow for lymphoma regression post H. pylori eradication. 3. Lymphoma regression with H. pylori still present when a trial of a second line eradication therapy would be indicated. 4. Lymphoma still present and H. pylori still detectable when if the lymphoma is stable and asymptomatic second line eradication therapy may be reasonable. For progressive or symptomatic disease radiotherapy or single agent chemotherapy would be given. Early stage