恶性肿瘤并发深静脉血栓形成43例临床分析

目的：探讨恶性肿瘤合并深静脉血栓的临床特点、诊断方法及治疗原则。方法：回顾性分析43例恶性肿瘤合并深静脉血栓患者的诊断、治疗及生存情况。43例患者经过D-二聚体筛查、血管加压超声和/或磁共振血管成像检查确诊。全部患者接受了低分子肝素抗凝及改善循环治疗。结果：经治疗1月后,37（86%）例患者栓塞症状缓解。随访1年,31例死亡。1年生存率28%。结论：深静脉血栓是晚期恶性肿瘤的常见并发症,其发生发展与肿瘤进展及各种抗肿瘤措施有一定的相关性。具有潜在的致死性,治疗复杂,预后不良。抗凝治疗为此类患者的基础治疗,具有良好的安全性。     

恶性肿瘤并发深静脉血栓形成43例临床分析

目的:探讨恶性肿瘤合并深静脉血栓的临床特点、诊断方法及治疗原则。方法:回顾性分析43例恶性肿瘤合并深静脉血栓患者的诊断、治疗及生存情况。43例患者经过D-二聚体筛查、血管加压超声和/或磁共振血管成像检查确诊。全部患者接受了低分子肝素抗凝及改善循环治疗。结果:经治疗1月后,37(86%)例患者栓塞症状缓解。随访1年,31例死亡。1年生存率28%。结论:深静脉血栓是晚期恶性肿瘤的常见并发症,其发生发展与肿瘤进展及各种抗肿瘤措施有一定的相关性。具有潜在的致死性,治疗复杂,预后不良。抗凝治疗为此类患者的基础治疗,具有良好的安全性。     

肝素及其类似物抗乳腺癌作用研究进展

肿瘤是深静脉血栓形成的高危因素之一,因而很多肿瘤患者会伴发静脉血栓形成,这使得抗凝治疗必不可少。近期很多临床研究及Meta分析表明,肿瘤患者在接受抗凝治疗后,生存期得到明显改善。肝素是一种广泛应用于静脉血栓的抗凝剂,据此,研究人员提出猜想:肝素是否具有抗肿瘤活性?大量实验性研究就此全面开展,结果证实:普通肝素、低分子肝素、肝素各种化学衍生物与多种肿瘤的发生、发展进程相关。该文主要概述了肝素及其类似物抗乳腺癌的作用及其可能的内在机制。     

恶性肿瘤抗凝治疗后肝素诱导血小板减少症的诊断与治疗进展

恶性肿瘤患者多伴有凝血机制的异常,如血小板增多、血小板聚集功能亢进等,从而导致血栓发生,是恶性肿瘤最常见的并发症之一。根据发生血栓的流行病学调查显示,恶性肿瘤患者发生静脉血栓栓塞症（VTE）的风险约为非恶性肿瘤患者的4～7倍。目前有关发生恶性肿瘤相关血栓的危险因素包括患者、恶性肿瘤及治疗相关因素,可根据恶性肿瘤相关血栓的生物学标志物及其危险模型进行评估,并对其进行预防及治疗。恶性肿瘤患者发生VTE一般采用肝素或低分子肝素治疗,但经肝素抗凝治疗后又常常发生血小板减少,导致患者的皮肤黏膜广泛出血及器官出血。因此,本文就恶性肿瘤相关血栓发生的原因、抗凝治疗后肝素诱导血小板减少症的临床和实验室诊断及其临床治疗进展作一综述,供血液肿瘤科的临床医师讨论和参考。     

恶性肿瘤合并静脉血栓栓塞症21例临床分析

目的探讨恶性肿瘤合并静脉血栓栓塞症（VTE）高危因素、诊断、治疗以及预防。方法回顾性分析21例恶性肿瘤合并静脉血栓栓塞症的临床资料。结果 21例病例中1例深静脉血栓形成（DVT）患者因为活动性咯血而未进行抗凝治疗,随诊发现患者患肢肿胀加重,超声复查提示血栓较前增大。1例肺血栓栓塞症（PTE）患者因病情危重未来得及行抗凝治疗以及溶栓治疗已经死亡。另1例PTE患者经对症治疗病情稳定后接受低分子肝素、华法林抗凝治疗,复查超声提示静脉血栓较前缩小。其余18例DVT患者经过抗凝治疗后患肢肿胀,疼痛减轻、消失或（和）超声检查提示静脉血栓较前缩小、消失,血流恢复通畅。结论通过分析恶性肿瘤合并静脉血栓栓塞症高危因素、诊断、治疗以及预防,提高DVT诊疗水平,减少PTE的发生,对防治VTE有重要意义。     

低分子肝素抗凝治疗延长肿瘤患者生存机制的研究进展

肿瘤患者凝血系统常被激活而处于高凝状态,易于形成血栓.静脉血栓事件的防治是目前肿瘤研究中的热点.近年来有研究表明低分子肝素在治疗肿瘤患者深静脉血栓形成的同时能延长患者的生存.本文简要综述有关低分子肝素抗凝治疗延长肿瘤患者生存及其分子机制的研究进展.     

肿瘤与血栓形成研究进展

血栓形成与肿瘤形成关系密切,其机制与肿瘤本身及释放的因子和治疗相关.大部分肿瘤血栓患者可通过初步筛查检测出来.美国胸科协会已发布抗凝指南,其中低分子肝素抗凝同时亦抗肿瘤.     

超声监测胸外科肿瘤术后低分子肝素预防深静脉血栓的临床研究

目的探讨应用超声监测胸外科肿瘤术后给予低分子肝素预防深静脉血栓的临床效果。方法将2010年1月至2010年12月间80例行胸外科恶性肿瘤手术治疗的患者随机分为两组,每组各40例。观察组患者术后给予低分子肝素治疗,对照组患者术后未给予低分子肝素治疗,对两组患者进行超声检查,观察深静脉血栓发生的情况。结果两组患者手术时间、胸腔引流量、拔管时间比较差异无统计学意义（P〉0．05）;观察组患者静脉血栓形成率显著低于对照组,差异有统计学意义（P〈0．05）;两组患者D-二聚体、血小板计数（PLIT）和纤维蛋白原（FIB）治疗后均有不同程度的改善,差异有统计学意义（P〈0．05）。治疗1d后两组患者的观察指标比较无显著性差异（P〉0．05）,但治疗3天后,FIB和D-二聚体比较,差异有统计学意义（P〈0．05）。结论临床上胸外科肿瘤手术后给予低分子肝素能够有效预防深静脉血栓的形成,超声能够作为早期监测患者下肢深静脉血栓形成的重要方法。     

恶性肿瘤与静脉血栓栓塞的研究进展

静脉血栓栓塞（VTE）是恶性肿瘤患者常见并发症,是仅次于肿瘤本身引起患者死亡的第二位原因。血栓有时可作为隐匿性癌的初始表现。血栓形成参与了肿瘤的进展、血管生成和转移等机制。恶性肿瘤患者合并血栓栓塞不仅增加治疗难度,而且降低患者的生存质量并缩短生存时间。抗凝治疗不仅能有效的治疗血栓,而且具有一定的抗肿瘤作用。低分子肝素（LMWH）作为预防和治疗静脉血栓栓塞有效的和安全的首选药物,其优点包括延长生存时间和改善生活质量,减少静脉血栓栓塞的发生率。推荐在院的及接受手术治疗的肿瘤患者预防性使用LMWH。LMWH应作为已确诊的和存在再发可能的VTE的肿瘤患者的一线治疗。     

恶性肿瘤与静脉血栓栓塞的研究进展

静脉血栓栓塞(VTE)是恶性肿瘤患者常见并发症,是仅次于肿瘤本身引起患者死亡的第二位原因。血栓有时可作为隐匿性癌的初始表现。血栓形成参与了肿瘤的进展、血管生成和转移等机制。恶性肿瘤患者合并血栓栓塞不仅增加治疗难度,而且降低患者的生存质量并缩短生存时间。抗凝治疗不仅能有效的治疗血栓,而且具有一定的抗肿瘤作用。低分子肝素(LMWH)作为预防和治疗静脉血栓栓塞有效的和安全的首选药物,其优点包括延长生存时间和改善生活质量,减少静脉血栓栓塞的发生率。推荐在院的及接受手术治疗的肿瘤患者预防性使用LMWH。LMWH应作为已确诊的和存在再发可能的VTE的肿瘤患者的一线治疗。     

乳腺癌术后肺栓塞27例临床特征分析

目的 探讨乳腺癌外科术后肺栓塞的临床特征.方法 选取2008年1月1日至2020年1月1日在北京大学肿瘤医院行乳腺癌手术后出现肺栓塞的患者27例,收集并分析其临床资料、诊断结果、治疗及预后等.结果 入组的27例肺栓塞患者的临床表现无特异性,均通过肺动脉CT血管造影(CTPA)显示动脉充盈缺损确诊,其中双侧肺栓塞18例,...     

Treatment of venous thrombosis in cancer patients: practical aspects

The risk of venous thromboembolism (VTE) is increased in association with malignancy, and has a potential to produce significant morbidity and mortality. Treatment of such patients with anticoagulants is associated with both benefit and a high rate of complications. In the early phase, the treatment is usually achieved with low molecular weight heparin (LMWH), which has a number of advantages over unfractionated heparin (UFH): once or twice daily administration, no necessary laboratory monitoring, lesser risk of bleeding and no drugs interactions. Nevertheless, the UFH is the anticoagulant of choice when a rapid anticoagulant effect or stop of anticoagulant effect is required, in the treatment of massive pulmonary embolism or severe renal insufficiency. Prolonged anticoagulation with LMWH (over 3 or 6 months) appears to be beneficial on survival for such patients. The subject of anticoagulation in patients with primary or secondary brain tumours is controversial. The long-term anticoagulation mainly use LMWH or vitamin K antagonist. The last ones are more difficult to use because of an unpredictable response with higher rate of recurrence and bleeding. The optimal duration of treatment is not known but the patients should be treated for at least 6 months, even at least 12 months after a second episode of venous thromboembolism. On the primary prevention in high-risk surgical oncology, the LMWH are at least as effective and safer as UFH when the optimal dose was administered. For the medical patients, the use of prophylactic anticoagulant treatment is less clear except the patients who are bedridden for prolonged periods of time. For the secondary prevention, the LMWH seems to be more effective over vitamin K antagonists. For these patients, the anticoagulant therapy is recommended indefinitely or until cancer is resolved.     

Management of venous thromboembolism in cancer patients

Venous thromboembolism is a common complication in patients with cancer. The management of deep-vein thrombosis and pulmonary embolism can be a considerable challenge in these patients. Diagnosing venous thrombosis requires objective testing, and noninvasive investigations may be less accurate in patients who have cancer than in those who do not. Treatment of acute venous thrombosis at home with low-molecular-weight heparin is an attractive option in patients with malignant disease, in whom quality of life is especially important. Comorbid conditions, warfarin resistance, difficult venous access, and a potentially high bleeding risk are some of the factors that often complicate the prolonged course of anticoagulant therapy needed in this group. In addition, the use of central venous catheters is increasing, but the optimal treatment of catheter-related thrombosis remains controversial. This article reviews the current diagnostic and treatment approaches to venous thromboembolism in patients with cancer and provides several clinical scenarios to illustrate and discuss some common management problems.     

经肝动脉栓塞化疗联合陀螺刀治疗原发性肝癌的临床疗效

目的 观察经肝动脉栓塞化疗（transcatheter arterial chemoembolization,TACE）联合陀螺旋转式60Co放射治疗系统（以下简称陀螺刀）治疗原发性肝癌的疗效。方法 选择2008年6月至2011年1月本院收治的原发性肝癌患者71例,按不同治疗方法分为TACE治疗组35例及TACE联合陀螺刀治疗（联合治疗组）36例,比较两组患者的治疗效果。结果 联合治疗组的有效率为77.8%,明显高于TACE治疗组的54.3%,差异有统计学意义（P〈0.05）。联合治疗组和TACE治疗组的6个月、12个月、18个月、24个月生存率分别为97.2%、83.8%、52.8%、41.7%和71.4%、51.4%、34.3%、28.6%,差异均有统计学意义（P均〈0.05）。联合治疗组行陀螺刀放疗过程中有3例（8.3%）发热,4例（11.1%）出现肝功能损害,均未发生骨髓抑制及放射性肺炎。结论 TACE联合陀螺刀治疗原发性肝癌的疗效优于单纯TACE治疗,可提高患者的生存率,毒副反应较少,值得临床推广应用。     

89SrCl2治疗前列腺癌骨转移27例疗效分析

目的探讨氯化锶（^89SrCl2）治疗前列腺癌骨转移的疗效。方法采用静脉注射^89SrC2（1．48—2．22MBq/kg体重）治疗27例患者前列腺癌骨转移病灶及疼痛。随访时间6个月。结果^89SrCl2治疗后无效4例（14．8％）；有效16例（59．3％）；显效7例（25．9％）。总有效率为85．2％。部分患者复查骨显像显示，原异常浓聚影明显缩小、减少和／或消失。PSA检查15例（55．5％）较治疗前下降，4例（14．8％）降至20ng／ml以下。70．4％的患者在接受^89SrCl2治疗后，白细胞和血小板计数轻度下降，在3～5个月内恢复到治疗前水平。结论^89SrCl2可以安全、有效地缓解骨转移癌所致疼痛。     

Catheter-related thrombosis: risks, diagnosis, and management

Symptomatic thromboembolic complications of central venous catheters (CVCs) occur in 5% or less of general oncology patients. Asymptomatic CVC-related thrombi are more common, but their clinical significance is unclear. Thrombotic risk may be increased by primary thrombophilic disorders, especially the factor V G1691A (Leiden) mutation, thrombogenic catheter material, larger catheter diameter and greater number of lumens, catheter tip malposition, left-sided placement, percutaneous or multiple insertion attempts, a previous CVC or preexisting venous obstruction, prothrombotic therapeutic agents, catheter-associated infections, and fibrinous catheter lumen occlusion. Three recent randomized, prospective, placebo-controlled trials observed no benefit of routine low-dose warfarin or low-molecular-weight heparin in preventing catheter-associated thrombosis. Nevertheless, thromboprophylaxis may be appropriate and safe for selected high-risk patients. Duplex ultrasound can accurately detect CVC-related thrombi involving the jugular, axillary, distal subclavian, and arm veins. Contrast venographic imaging is required for indeterminate duplex findings and to evaluate the deep central veins and pulmonary arteries. Therapeutic anticoagulation, with or without catheter removal, is indicated for patients with acute deep vein thrombosis (DVT) or pulmonary embolism who have no contraindications. Catheter removal alone, with close follow-up, may be sufficient when bleeding risk precludes safe anticoagulation. Approaches to managing catheter-associated thrombosis, including the use of thrombolytic agents, are guided by limited published experience and extrapolation from practices used for lower-extremity DVT. Prospective, randomized, controlled trials are needed to identify the safest and most effective anticoagulant agents, treatment durations, and alternative venous access strategies for cancer patients who develop catheter-associated thrombosis.     

Venous thromboembolism associated with long-term use of central venous catheters in cancer patients.

Long-term central venous catheters (CVCs) have considerably improved the management of cancer patients because they facilitate chemotherapy, transfusions, parenteral nutrition, and blood sampling. However, the use of long-term CVCs, especially for chemotherapy, has been associated with the occurrence of upper-limb deep venous thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to CVCs has been reported to vary between 0.3% and 28.3%. The incidence of CVC-related UL-DVT screened by venography reportedly varies between 27% and 66%. The incidence of clinically overt pulmonary embolism (PE) in patients with CVC-related UL-DVT ranges from 15% to 25%, but an autopsy-proven PE rate of up to 50% has been reported. Vessel injury caused by the procedure of CVC insertion, venous stasis caused by the indwelling CVC, and cancer-related hypercoagulability are the main pathogenetic factors for CVC-related venous thromboembolism (VTE). Several studies have assessed the benefit of the prophylaxis of UL-DVT after CVC insertion in cancer patients. According to the results of these studies, prophylaxis with low molecular weight heparin or a low fixed dose of warfarin has been recently proposed. However, the limitations of the experimental design of the prophylactic studies do not allow definitive recommendations. The recommended therapy for UL-DVT associated with CVC is based on anticoagulant therapy with or without catheter removal. This review focuses on the epidemiology, pathogenesis, diagnosis, prevention, and treatment of VTE in cancer patients with long-term CVC.