克唑替尼治疗非小细胞肺癌患者致急性肺栓塞1例报道

1 病历简介
　　一位52岁的不吸烟女性患者,于2012年8月因肺癌行根治性切除术（右肺上叶切除并系统淋巴结清扫术）,术后病理为肺腺鳞癌（pT2a N2 M0,Ⅲa 期）。将术后病理组织行生长因子受体（epider －growth －factor receptor,EGFR）及 K －RAS突变状态检测均为野生型。患者接受了2个周期的含铂两药方案术后辅助化疗（多西他赛联合顺铂）。后因血液学毒性而未进一步化疗,予纵隔区放疗。之后患者定期复查未见异常。2013年3月,患者复查胸部 CT 检查提示：右侧胸膜腔少量积液。因当时其无不适,未予进一步诊治。至2013年9月,患者因气短再次就诊,复查胸部 CT 提示：右侧胸腔积液明显增多（图1）。遂行右侧胸腔穿刺排液术,于胸水中查见腺癌细胞,进一步行反转录聚合酶链反应检测提示：存在EML4－ALK 融合基因（图2）。随后患者接受了6个周期的含铂两药方案（培美曲塞联合顺铂）一线治疗,末次治疗于2014年1月结束。经过治疗,患者右侧胸腔积液明显减少（图3）。2014年3月,患者因头痛行头颅磁共振检查提示：左顶叶转移灶（图4左）。考虑疾病进展,予克唑替尼（250mg／次,2次／日,口服）靶向抗肿瘤治疗。2014年4月复查结果显示颅内转移灶缩小（图4右）,且右侧胸腔积液继续减少（图5）。2014年7月因复查发现颅内新增多发转移灶（图6）,在克唑替尼靶向治疗的基础上行全颅放疗。随后患者每2月复查1次,头颅转移灶渐缩小（图7）,肺内及其他部位未出现新增病灶,疾病控制良好,患者一般情况好。在患者口服克唑替尼治疗期间,除轻度的肝功能异常及恶心之外,无其他明显不良反应。2015年2月10日,患者无明显诱因突然出现气短、胸闷、痰中带血。急诊入院,查体：体温37．2℃、脉搏95次／分钟、呼吸32次／分钟、血压140／80mmHg。右残肺可闻及湿性音。     

肺癌术后急性肺栓塞六例临床分析

肺栓塞（pulmonary embolism，PE）为内源性或外源性栓子堵塞肺动脉或其分支引起的肺循环障碍的临床病理生理综合征。其起病凶险，一旦发生，死亡率很高。现将我科经历的6例肺癌术后由于体位变换诱发急性肺栓塞的病例分析如下。     

非小细胞肺癌并发肺栓塞患者差异基因lncRNA MALAT1的筛选与验证

目的 通过高通量测序(RNA-Seq)技术筛选非小细胞肺癌(NSCLC)并发肺血栓栓塞症(PTE)患者中差异基因表达谱,探讨长链非编码RNA(lncRNA)肺腺癌转移相关转录本1(MALAT1)与NSCLC并发PTE疾病的关联性。方法 收集2020-01-01-2020-12-30就诊于新疆医科大学附属肿瘤医院确诊的NSCLC并发PTE患者、单纯NSCLC患者及同期门诊健康体检者的临床资料及其外周血样本各4例。(1)差异基因lncRNA MALAT1的筛选：NSCLC并发PTE患者、单纯NSCLC患者和健康体检者的外周血各4例,应用RNA-Seq行差异基因lncRNA表达谱测序,行基因本体论(GO)和京都基因与基因组百科全书(KEGG)数据库分析差异基因相关的富集及信号通路。(2)对筛选出的lncRNA MALAT1差异表达的验证：上述3组各30例,应用实时荧光定量聚合酶链反应法检测患者外周血MALAT1、缺氧反应诱导因子1α(HIF-1α)、尼克酰胺腺嘌呤二核苷酸磷酸氧化酶4(NOX4)及活性氧(ROS)的表达水平,通过单因素方差分析、LSD-t检验比较组间差异,采用简单线性回归分析...     

青年肺癌33例治疗体会

[目的]探讨青年肺癌的特点及影响预后的因素。[方法]分析在我院接受治疗的33例30岁以下青年肺癌患者。[结果]临床及病理分期Ⅰ期3例，Ⅱ期2例，Ⅲ期14例，Ⅳ期14例，病理诊断以小细胞未分化癌及低分化腺癌为主，就诊后一年内死亡36.4%(12/33)，1年生存率63.6%(21/33)，3年生存率43.3%(13/30)。5年生存率10.7%(3/28)。[结论]青年肺癌就诊时间晚，恶性程度高，病情发展迅速、转移早、预后差。术前化疗、手术及术后化、放疗的综合治疗是提高青年肺癌生存率的关键。     

肺癌术后并发急性肺栓塞猝死误诊原因分析

为了分析肺癌术后发生急性肺栓塞误诊及治疗失败的原因,对5例误诊的急性肺栓塞患者的临床资料进行回顾性分析。肺癌手术956例,发生急性肺栓塞死亡5例,肺栓塞发生率为0.52%。肺栓塞平均发病时间为5.8 d,确诊时间为肺栓塞发生后平均2.4 d,死亡时间为肺栓塞发生后平均1.8 d。临床表现为突发严重呼吸困难。初步研究结果提示,对急性肺栓塞的认识不足、缺乏特异性的临床表现及综合分析不够全面是导致误诊的主要原因。     

肺癌胸水综合治疗20例报告

长期以来,我们对晚期肺癌胸水都采用传统的方式用全身化疗、局部给药(抽胸水后单一给药或联合化疗,药物注入胸腔,或注入免疫药物或胸腔粘合剂)。有的主张排胸水、后放疗,外科胸腔引流,一般治疗4~5周,疗效50%左右,复发50~70%。1994年以来我们对20例晚期肺癌胸水行综合治疗,症状明显缓解,一个月后复查,总有效率87.5%,取得了较好的疗效。     

肺癌术后肺栓塞的防治

目的探讨能有效地降低或避免肺癌术后的肺栓塞并发症的围手术期治疗方案。方法新方案包括：全肺者肺动脉处理术式改变;改变术中、术后输液径路;术后放弃所有止、凝血药物的使用;术后24h开始常规应用抗凝药物;早期下床活动;比较新治疗方案实施前后为两组患者,术后下肢深静脉血栓及肺栓塞发生率。结果实施新治疗方案前,术后下肢深静脉血栓发生率为2．84％（9／316）,肺栓塞发生6例,发生率为1．8％,死亡4例率;实施新治疗方案后,术后下肢深静脉血栓发生率及肺栓塞发生率均为0（0／169）（P〈0．05）。结论预防性治疗方案可以降低术后下肢深静脉血栓形成率和肺栓塞的发生率。     

误诊肺癌20例原因分析

从1981年我院肿瘤科成立以来,作者搜集由各级医生误诊的肺癌病例20例。现将其误诊原因分析如下。临床资料误诊的肺癌患者共20例。其中男16例,女4例,平均年龄58.2岁。被误诊的疾病中,有肺结核6例,恶性淋巴瘤3例,先天心3例,甲状腺瘤3例,肺内感染2例,胸膜壁层结核瘤1例,心包囊肿1例,主动脉瘤1例。     

肺癌脑转移24例治疗体会

目的 探讨肺脑转移多发或单发病灶、位于手术禁区或手术、放疗达阳期效果的，通过药物治疗达到治疗效果。方法 首先采用脱水剂使血脑屏障开放再给予化疗药物，能最大限度的使药物充分发挥作用同时给予综合支持治疗。结果 通过静脉用药，方法简便易行，各类脑转移病人均可应用，不受手术指征及放疗指征的限制。结论 通过临床观察，ＶＭ－２６（鬼臼噻吩甙）与ＣＣＮＵ（洛莫司汀）联合应用是当前临床治疗肺癌转移较好的方案，可以     

肺癌伴肺栓塞患者影像学和临床因素与D-二聚体的相关性研究

目的 肺癌患者易并发肺栓塞,死亡风险增加.D-二聚体(DD)是肺栓塞常用辅助诊断指标,与恶性肿瘤进展、转移及预后关系密切.本研究分析肺癌合并肺动脉栓塞患者影像学及临床因素与DD之间的相关性.方法 收集2014-09-01-2015-08-31山东省肿瘤医院收治的病理确诊为肺癌,并经多层螺旋CT显示有肺栓塞者59例作为研究对象,回顾性分析其影像学和临床资料.根据栓子影像指标和患者临床资料分组分析,运用SPSS17.0统计学软件分析其与DD的相关性.结果 瘤栓组(n=30)平均血浆DD水平为11.29 mg/L,血栓组(n=29)为7.48mg/L,差异有统计学意义,P=0.049.Ⅲ～Ⅳ期患者(n=21)平均血浆DD水平为l0.13mg/L,Ⅰ～Ⅱ期(n=38)为7.96 mg/L,差异有统计学意义,P=0.042.淋巴结转移组(n=45)平均血浆DD水平为11.01 mg/L,无淋巴结转移组(n=14)为4.31 mg/L,差异有统计学意义,P=0.006.发生远处转移组(n=39)平均血浆DD水平为9.88 mg/L,无远处转移组(n=20)为7.76 mg/L,差异有统计学意义,P=0.045.分化差肺癌患者(n=36)平均DD水平为10.67 mg/L,分化良好肺癌患者(n=23)为6.8 mg/L,差异有统计学意义,P=0.039.肿瘤标记物升高组(n=39)平均血浆DD为10.65 mg/L,正常组(n=20)为6.26 mg/L,差异有统计学意义,P=0.023.结论 DD水平在瘤栓、晚期患者、淋巴结转移、远处转移、分化差、肿瘤标记物升高的患者较高,与上述因素间有相关性.DD在肺癌并发肺栓塞的预防、诊断、治疗等方面有一定临床价值.     

肺结核合并肺癌的影像和临床特点及误诊原因分析

目的：总结肺结核合并肺癌的临床和影像学特点，以提高诊断水平，减少误诊。方法：回顾2001年1月-2008年1月期间确诊为肺结核合并肺癌以及初诊分别为肺结核和肺癌而进一步确诊为肺癌和肺结核病的临床和影像资料。结果：在收治的15660例肺结核病人中，肺结核合并肺癌182例（1．16%），其中肺癌病灶发生在肺结核所在肺叶或肺段63例；临床诊断为肺癌而行剖胸探查的2588例病人术后病理确诊为肺结核合并肺癌22例（0．85％）。主要症状为刺激性咳嗽、发热、盗汗等。肺部影像表现为偏心空洞、肿块周围毛刺状、肺不张以及胸腔积液等，同时也具有各型肺结核的影像特点。结论：肺结核合并肺癌以及肺结核与肺癌的临床鉴别诊断在临床上较为困难，应认真进行相关辅助检查以防止误诊、漏诊。     

23例肺癌合并肺动脉栓塞病例分析

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．     

Disseminated microvascular pulmonary tumor embolism from non-small cell lung cancer leading to pulmonary hypertension followed by sudden cardiac arrest

Disseminated microvascular pulmonary tumor embolism (DMPTE) is extremely rare and invariably fatal. Typical symptoms and signs of DMPTE include shortness of breath and inadequate oxygenation. Here we demonstrate a patient with unexplained progressive pulmonary hypertension followed by sudden cardiac arrest, who finally diagnosed of DMPTE pathologically under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) system support.A 59-year-old gentleman was diagnosed of advanced non-small cell lung cancer with clinical stage of T3N2M1 in February 2008. His disease had been controlled well for two years under first-line clinical trial and salvage pemetrexed treatment. In early January 2010, he suffered from dyspnea on exertion gradually, although cancer progression was not proven by computed tomography (CT) scan. Transthoracic echocardiography also revealed normal heart size and function. However, he was sent to emergency room (ER) one month later due to dyspnea where pulmonary hypertension was discovered by repeated echocardiography. Follow-up CT scan was shown neither evidences of tumor progression nor pulmonary thromboembolic event in all major pulmonary vessels. Unfortunately, he was found to be unconscious suddenly at ER during urination and diagnosed as pulse-less electrical activity. Cardiopulmonary resuscitation (CPR) was initiated immediately and he was sent to intensive care unit with VA-ECMO system under the impression of cardiovascular system dysfunction. He passed away 10 days after intensive treatment. A necropsy was performed after we received the inform consent from his family. DMPTE was confirmed by pathologists. Currently, diagnosis of DMPTE is challenging and treatment is limited although advances of modern medicine. DMPTE should be kept in mind if cancer patients have dyspnea, inadequate oxygen saturation and unexplained pulmonary hypertension during their disease courses that unexpected serious consequences, like sudden cardiac arrest, may happen.     

Comparison of lung scintigraphy and CT angiography in the diagnosis of pulmonary embolism

In our institution, as in others, pulmonary angiography is not used in the diagnosis of pulmonary embolism because of its perceived risks. We compared the results on lung scintigraphy and computed tomography angiography (CTA) in 116 consecutive patients with suspected pulmonary embolism. In 14 patients with normal lung scans 13 (93%) were also normal with CTA. In the 73 patients with low probability lung scans only five (7%) demonstrated pulmonary embolism with CTA. In 12 patients with high probability lung scans 11 (92%) demonstrated pulmonary embolism on CTA. However, in the 17 patients with intermediate probability lung scans, 10 (58.8%) showed embolism with CTA. We conclude that wherever practicable lung scans should be performed in all patients due to its relatively low radiation burden and that CTA be performed in patients with intermediate probability scans due to the high incidence of pulmonary embolism. Patients with either a normal scan or high probability scan should be treated appropriately. In patients with low probability scans CTA should be performed in those with a high clinical suspicion of thromboembolism.     

Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center

BACKGROUND:

Incidence of pulmonary embolism (PE) for different cancer types in oncology outpatients is unknown. The purposes of the current study is to determine the incidence of PE in oncology outpatients and to investigate whether the incidence for PE is higher in certain cancers.

METHODS:

A cohort of oncology outpatients who had imaging studies at Dana‐Farber Cancer Institute, a tertiary outpatient cancer institute, from January 2004 through December 2009 was identified using research patient data registry. Radiology reports were reviewed to identify patients who developed PE. Incidences of PE in the total population and in each of 16 predefined cancer groups were calculated. Risk of PE for each cancer was compared using Fisher exact test.

RESULTS:

A total of 13,783 patients was identified, of which 395 (2.87%; 95% confidence interval [CI], 2.59‐3.16) developed PE. The incidence of PE was highest in the central nervous system ([CNS] 12.90%; 95% CI, 8.45‐18.59), hepatobiliary (6.85%; 95% CI, 3.33‐12.24), pancreatic (5.81%; 95% CI, 3.59‐8.84), and upper gastrointestinal (5.81%; 95% CI, 3.96‐8.20) malignancies. The risk of PE was significantly higher for CNS (P < .0001; odds ratio [OR], 5.28), pancreatic (P = .0027; OR, 2.15), upper gastrointestinal (P = .0002; OR, 2.18), and lung/pleural malignancies (P = .0028; OR, 1.45). There was significantly lower risk of PE for hematologic (incidence, 1.16%; 95% CI, 0.79‐1.64; P < .0001; OR, 0.35) and breast malignancies (incidence, 1.50%; 95% CI, 1.02‐2.11; P < .0001; OR, 0.47).

CONCLUSIONS:

The incidence of PE in oncology outpatients in a tertiary cancer center during a 6‐year period was 2.87%. CNS, pancreatic, upper gastrointestinal, and lung/pleural malignancies had a significantly higher risk for PE than other malignancies, whereas hematologic and breast malignancies had a significantly lower risk. Cancer 2011. © 2011 American Cancer Society.     

妇科围手术期肺栓塞21例临床分析

目的 肺栓塞具有发病急、病情重、病死率高、预后差等临床特点.通过分析妇科围手术期患者肺栓塞的发生情况,提高围手术期防治肺栓塞的意识,减少肺栓塞发病率,提高其诊断率.方法 回顾性分析2005-01-01-2015-06-30北京大学第三医院妇产科妇科病房21例围手术期肺栓塞患者的临床资料.21例肺栓塞患者中位年龄63岁.发生于手术后15例,其中恶性肿瘤11例(73.3％);发生于术前6例.结果 21例患者中,出现胸闷气短9例,咳嗽6例,呼吸困难3例,胸痛1例,晕厥4例,咯血1例,无症状5例.20例经肺CT肺动脉造影(computed tomographic pulmonary angiography,CTPA)检查的患者中有19例获得明确诊断,1例CTPA未见栓子,行肺灌注扫描,表现为肺多发血流灌注减低,呈外周分布,以亚段性为主;另外1例有癫痫病史直接经肺灌注确诊.21例患者给予溶栓、抗凝和(或)介入等治疗,20例好转,因病情严重放弃治疗1例.结论 肺栓塞临床表现差异大,出现典型呼吸困难、胸痛、咳血典型三联症状较为少见.手术是引起肺栓塞的重要危险因素,也可发生于术前,尤其是合并恶性肿瘤的老年患者,应引起警惕.肺栓塞风险评估后积极预防可明显降低围手术期肺栓塞发生率.对于易患因素者,CTPA和肺灌注扫描有助于早期发现肺栓塞.     

妇科肿瘤术后并发肺栓塞4例报告及诊治分析

目的:探讨妇科肿瘤术后并发肺栓塞(PE)的临床表现和诊治策略.方法:回顾性分析2019年01月至2019年10月空军军医大学西京医院收治的4例妇科肿瘤术后并发肺栓塞患者的临床资料、诊疗方法及疾病转归情况.结果:4例患者均为术后2～4天诊断肺栓塞,表现为不同程度的呼吸困难、胸闷、气短、咳嗽、嗜睡.病例4术后转入麻醉ICU...     

姜黄素对急性肺动脉栓塞大鼠肺损伤及CFTR表达的影响

目的：观察姜黄素对急性肺栓塞大鼠肺损伤的保护作用及对CFTR表达的影响。方法：大鼠分为假手术组,模型组,姜黄素（150mg/kg）﹢APE组。制备左肺动脉结扎模拟急性肺动脉栓塞模型。进行血气分析,检测AFC及肺湿干比,real-time PCR方法检测肺组织的CFTR的表达。结果：与模型组比较,姜黄素升高PaO2水平,减轻AFC下降趋势,及减少肺湿干比的增加。姜黄素能提高肺组织的CFTR的表达。结论：姜黄素对急性肺动脉栓塞大鼠的急性肺损伤有保护作用,并上调CFTR的表达。