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23例肺癌合并肺动脉栓塞病例分析
引用本文:邵磊,王哲海,左建云. 23例肺癌合并肺动脉栓塞病例分析[J]. 癌症, 2009, 28(4): 416-419
作者姓名:邵磊  王哲海  左建云
作者单位:山东省肿瘤医院内三科,山东济南,250117;济南市中心医院呼吸内科,山东济南,250013;山东省肿瘤医院内三科,山东济南,250117;济南市中心医院呼吸内科,山东济南,250013
摘    要:
背景与目的:肺动脉栓塞在肺癌病例中是一种发病率、误诊率及病死率高的并发症。本研究拟通过探讨肺癌合并肺动脉栓塞的临床特点和诊断、治疗方法,以期提高其诊疗水平。方法:回顾性分析23例肺癌合并肺动脉栓塞病例的一般资料和临床表现、伴随的基础疾病及危险因素、间接诊断及直接诊断的方法,以及治疗原则和方法。结果:间接检查方法中,血气分析结果示14例(60.87%)存在低氧血症,血浆D-二聚体检查结果示23例(100%)增高,心电图检查11例(47.83%)有特征性变化。直接检查方法中,肺同位素血流灌注扫描2例(100%)发现肺段灌注缺损,螺旋CT检查12例中有10例(83.33%)发现肺动脉内充盈缺损,MRI检查1例(100%)提示肺动脉内充盈缺损,肺动脉造影检查1例(100%)发现肺动脉血栓直接征象。5例对症治疗者的中位生存时间为13d,4例溶栓者为22.5d,12例抗凝并同时化疗者为93d,2例单纯抗凝治疗者分别生存70d和189d。结论:对肺癌同时合并肺动脉栓塞的诊断应依靠直接诊断法,治疗首推溶栓和抗凝,可尝试化疗.

关 键 词:肺肿瘤  肺动脉栓塞  危险因素  诊断  治疗  尿激酶  低分子肝素钙

Clinical analysis of 23 lung cancer patients accompanied by pulmonary embolism
Lei Shao,Zhe-Hai Wang,Jian-Yun Zuo. Clinical analysis of 23 lung cancer patients accompanied by pulmonary embolism[J]. Chinese journal of cancer, 2009, 28(4): 416-419
Authors:Lei Shao  Zhe-Hai Wang  Jian-Yun Zuo
Affiliation:Lei Shao, Zhe-Hai Wang, Jian-Yun Zuo(1. Department of Oncology , Shandong Cancer Hospital, Jinan , Shandong, 250117, P. R. China; 2. Department of Respiratory Medicine, Central Hospital of Jinan City, Jinan , Shandong , 250013, P.R. China)
Abstract:
Background and Objective: Pulmonary embolism (PE) is a common complication in lung cancer patients with a high misdiagnosis rate and high mortality. This study was to investigate the clinical characteristics, diagnosis and treatment approaches for lung cancer accompanied by PE, thus to improve the diagnosis and treatment efficacy of this disease. Methods. Clinical manifestations, comorbid conditions, risk factors, laboratory (indirect) and imaging examinations (direct) and treatment methods of 23 lung cancer patients with PE were retrospectively analyzed. Results. Among the 23 patients, 14(60.87%) had hypoxemia, all (100%) had elevated serum D-dimer, 11 (47.83%) had characteristic changes in electrocardiogram. Ten out of 12 cases (83.33%) examined by computed tomography angiography were found filling defect in the pulmonary artery; all two case receiving isotope perfusion scanning were detected segmental perfusion defect in the lung; one case undergoing MRI was found segmental filling defect in the pulmonary artery; and one case was discovered the direct sign of PE by pulmonary arteriography. The medium survival time (MST) of five cases who received symptomatic treatment was 13 days, of four cases who received thrombolysis therapy was 22.5 days, of 12 cases who underwent anticoagulation and chemotherapy was 93 days, and of two cases who were only given anticoagulant therapy were 70 days and 189 days respectively. Conclusions. Diagnosis of lung cancer accompanied by PE mainly depends on direct examinations. Thrombolysis and anticoagulation therapy are recommended for those patients. In addition, chemotherapy may also be considered.
Keywords:lung neoplasm   pulmonary embolism   risk factor   diagnosis   therapy
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