以静脉血栓为首发表现的恶性肿瘤23例

目的 分析以静脉血栓为首发表现的恶性肿瘤患者的临床特点,进一步探讨深静脉血栓与恶性肿瘤的关系.方法 分析23例以深、浅静脉血栓形成为首发表现的恶性肿瘤患者的临床表现、栓塞部位、是否合并肺栓塞、凝血功能检测指标、血小板计数、原发肿瘤类型、转移与否以及抗凝治疗效果,分析肿瘤与深静脉血栓形成的关系.结果 深静脉血栓形成16例（上肢3例,下肢13例）,游走性血栓性浅静脉炎7例（上肢2例,下肢4例,胸壁1例）,凝血功能检查示血浆纤维蛋白原含量、血小板计数均不同程度升高或降低,抗凝血酶活性不同程度下降,D-二聚体水平增高,5例合并远处脏器转移.抗凝治疗及腔静脉滤器降低血栓复发、大出血及致死性肺栓塞.结论 不明原因的静脉血栓患者应高度警惕肿瘤的存在,抗凝治疗及腔静脉滤器是降低并发症的重要保证.     

肿瘤患者腔静脉滤器置入并静脉溶栓治疗护理进展

预防性置入下腔静脉滤器并静脉溶栓是肿瘤患者并发深静脉血栓形成的新技术,本文就近年来腔静脉滤器置入并静脉溶栓治疗的护理进行综述.     

肿瘤患者腔静脉滤器置入并静脉溶栓治疗护理进展

预防性置入下腔静脉滤器并静脉溶栓是肿瘤患者并发深静脉血栓形成的新技术，本文就近年来腔静脉滤器置入并静脉溶栓治疗的护理进行综述。     

乳腺癌患者携带PICC化疗并发PICC相关性上肢深静脉血栓形成的诊治探讨

目的:探讨乳腺癌患者携带PICC化疗出现PICC相关性上肢深静脉血栓形成的发生及其临床诊治.方法:回顾性分析本院2009年8月～2011年7月携带PICC化疗的187例乳腺癌患者中PICC相关性上肢深静脉血栓形成的发生及其临床诊治情况.结果:187例携带PICC化疗的乳腺癌患者,共放置PICC188根,PICC管总置管...     

淋巴瘤相关血栓的临床分析

  目的  本研究主要分析和总结淋巴瘤（Malignant lymphoma, ML）患者发生静脉血栓栓塞（venous thrombolism, VTE）的临床特点, 为预防和治疗ML相关VTE提供有效依据。  方法  回顾性分析天津医科大学附属肿瘤医院2000年1月至2009年12月收治的经病理证实的4 256例ML患者的临床资料, 病理诊断依据WHO的造血与淋巴组织肿瘤分类标准（第4版）。  结果  ML相关VTE的发病率为7.1%, NHL患者并发VTE的发病率为5.7%, HL患者并发VTE的发病率为1.3%;16.4%的患者在治疗前形成血栓, 75.8%的患者血栓发生在化疗的前3个周期。上肢和颈部静脉血栓事件共146次（48.4%）, 下肢静脉血栓事件共89次（29.5%）。  结论  ML相关VTE的发病率较高, 上肢和颈部静脉血栓发生率较下肢更常见, 在化疗的前3个周期中血栓的发生率最高。      

列线图预测恶性肿瘤患者PICC导管相关血栓风险的研究

  目的  经外周中心静脉置管（peripherally inserted central catheters,PICC）在恶性肿瘤化疗中的应用越来越广泛,其导管相关血栓的发生率也呈现上升的趋势,显著影响患者的治疗及生存质量。  方法  回顾性分析2014年12月至2015年12月就诊于西安交通大学第一附属医院的286例进行PICC置管的恶性肿瘤患者相关临床资料,并对潜在的危险因素进行最小绝对收缩选择算子（least absolute shrinkage and selection operator,LASSO）回归分析,最终构建列线图模型。  结果  286例PICC置管患者中,72例出现导管相关血栓。将研究所纳入的27个潜在的血栓相关危险因素进行LASSO回归分析,结果显示进行外周血管穿刺时是否应用超声引导、患者既往是否接受过经外周静脉化疗、置管期间是否存在其他合并症以及置管时的血浆D-二聚体含量为影响PICC置管患者发生导管相关血栓的危险因素,最终应用上述风险因素构建列线图预测模型,其C-index指数为0.688,拟合曲线和校正后地拟合曲线均位于10%的误差范围内。  结论  结合穿刺技术、既往治疗,合并症以及D二聚体等因素所构建的列线图可以较准确的预测PICC相关血栓形成的风险,为临床诊疗工作的开展提供一定的理论基础和数据支持。      

乳腺癌术后发生下肢深静脉血栓的危险因素及血栓风险评估

  目的   研究乳腺癌患者术后发生下肢深静脉血栓(deep venous thrombosis,DVT)的危险因素,分析血栓风险评估模型的临床价值。  方法  回顾性分析2013年1月至2016年6月天津医科大学肿瘤医院703例术后发生血栓的患者为血栓组,通过系统抽样法选取对照组706例,分析乳腺癌患者术后发生下肢DVT的危险因素,并比较Khorana及Caprini血栓风险评估模型的预测价值。  结果  比较血栓组与对照组的年龄、BMI≥30 kg/m2、手术切除活检确诊、接受新辅助化疗、手术时间>2 h、治疗前脂蛋白a(Lpa)>475.5 mg/L、血浆蛋白C(PC) < 102.5%、血浆凝血因子Ⅷ(FⅧ)>129.8%及D-二聚体(D-D)>289.99 ng/mL,差异具有统计学意义(P < 0.05)。两组患者的Khorana风险评估模型进行比较,差异无统计学意义(P = 0.207);两组患者的Caprini风险评估模型进行比较,差异具有统计学意义(P < 0.001)。  结论   年龄、BMI≥30 kg/m2、手术切除活检确诊、接受新辅助化疗、手术时间>2 h、治疗前Lpa>475.5 mg/L、PC < 102.5%、FⅧ>129.8%及D-D>289.99 ng/mL是乳腺癌术后发生下肢DVT的独立危险因素,Caprini评估模型可能导致乳腺癌患者血栓风险评估偏高,应进一步探究更加适合乳腺癌患者血栓的风险评估模型。      

肿瘤细胞减灭加腹腔热灌注化疗术后静脉血栓栓塞症的预防

  目的  评估行肿瘤细胞减灭术（cytoreductive surgery，CRS）加腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy，HIPEC）治疗的腹膜癌患者静脉血栓栓塞症（venous thromboembolism，VTE）发生风险，研究术后早期主/被动活动联合间歇充气加压按摩对VTE的预防效果。  方法  对2015年5月至2016年8月武汉大学中南医院肿瘤科收治的120例胃肠道及妇科肿瘤等来源的腹膜癌患者行CRS+HIPEC治疗，使用Caprini血栓风险评估模型评价VTE风险，所有患者采取早期肢体主/被动活动及间歇充气加压按摩治疗，记录分析VTE相关事件。  结果  患者中位Carprini评分为12（10~16）分，均为VTE极高危组，在3个月的随访中仅1例患者发生深静脉血栓，经药物治疗后痊愈。  结论  腹膜癌患者VTE风险极高，术后早期足背曲/跖曲及扩胸等主/被动运动联合间歇充气加压按摩，可有效预防VTE。      

恶性肿瘤中心静脉置管并发血栓22例分析

目的：探讨中心静脉置管肿瘤患者发生血栓的原因及治疗对策。方法：对2003年-2006年808例中心静脉置管的恶性肿瘤患者发生深静脉血栓的病例进行回顾性分析。结果：22例发生深静脉血栓,4例腋静脉,18例股静脉。结论：术后及下肢静脉置管的肿瘤患者易发生血栓。贵要和锁骨下静脉穿刺置管可减少血栓发生。     

恶性肿瘤中心静脉置管并发血栓22例分析

目的:探讨中心静脉置管肿瘤患者发生血栓的原因及治疗对策.方法:对2003年-2006年808例中心静脉置管的恶性肿瘤患者发生深静脉血栓的病例进行回顾性分析.结果:22例发生深静脉血栓,4例腋静脉,18例股静脉.结论:术后及下肢静脉置管的肿瘤患者易发生血栓.贵要和锁骨下静脉穿刺置管可减少血栓发生.     

Treatment of deep vein thrombosis using temporary vena caval filters after allogeneic bone marrow transplantation

Bone marrow transplant (BMT) recipients have risk factors for deep vein thrombosis (DVT) including venous stasis caused by immobilization in the sterile unit, vessel wall damage caused by preparative regimen or indwelling catheters, and hypercoagulability caused by decreased natural anticoagulants. We successfully treated a patient who developed massive DVT in the superior vena cava after BMT with anticoagulation and the use of temporary vena caval filters. Considering the delayed complications, permanent filter is not appropriate for BMT recipients, because the risk factors for DVT associated with BMT are transient. We considered that temporary vena caval filter is a safe and useful device to prevent pulmonary embolism after DVT in BMT recipients.     

Potential endovascular prophylaxis for pulmonary thromboembolism in the combined treatment of cancer patients

Our study was concerned with the role of ultrasound examination of the lower extremity veins to detect deep venous thrombosis and to evaluate complex prophylaxis of thromboembolism of pulmonary arteries (TEPA). The procedure involved vena cava filter placement in patients with neoplasia and high risk of TEPA as compared with controls receiving conservative therapy alone. A positive correlation was established between surgery and/or polychemotherapy, on the one hand, and higher stage and high risk of TEPA, on the other. Patients with deep venous thrombosis and neoplasia were referred to groups of extremely high risk of that pathology. Angiological history, physical examination and ultrasound check-ups of the lower vein must be carried out in cancer patients. Vena cava filter placement proved to be an effective and safe measure of TEPA prophylaxis. It lowered the risk of lethal outcome in 24 during surgery and polychemotherapy. Lethality rate among controls was 43.5 +/- 0.51%.     

A case of huge colon carcinoma and right renal angiomyolipoma accompanied by proximal deep venous thrombosis, pulmonary embolism and tumor thrombus in the renal vein

A preoperative inferior vena cava (IVC) filter is reported to be effective in surgical cases with proximal deep venous thrombosis (DVT) or in which pulmonary embolism (PE) has already developed, and considered to be at high risk of developing secondary fatal PE during or after surgery. However, guidelines for using an IVC filter have yet to be established. The patient in the present report had two huge tumors, ascending colon cancer and renal angiomyolipoma, which occupied the entire right half of the abdomen, coexisting PE, DVT and tumor thrombus in the right renal vein. Secondary PE is fatal in the perioperative period, therefore, the vena cava filters were preoperatively inserted into the supra- and the infrarenal IVC. We successfully removed the tumors without complications. The patient is alive without tumor recurrence and PE or recurrent DVT 1 year and 6 months after surgery. The coexistence of two huge abdominal tumors as potential causes of PE and DVT is extremely rare, and we could have safely undergone the operation, using two vena cava filters in the supra- and infrarenal IVC.     

Persistent Left Superior Vena Cava in Hematological Malignancy Requiring Central Venous Catheter Insertion for Intensive Chemotherapy

Persistent left superior vena cava is a congenital vascular anomaly, which is possibly arrhythmogenic and thrombogenic, rarely complicated with coronary sinus atresia. We treated a 42-year-old male with Hodgkin''s lymphoma requiring central venous catheter placement for intensive chemotherapy. Persistent left superior vena cava was revealed after the insertion of the central venous catheter by the radiological finding of the catheter tip cannulated into the vena cava cavity. The relationship between coronary sinus atresia and persistent left superior vena cava induced by central venous catheterization remains unclear; however, the hematologist should pay attention to the malpositioning of the central venous catheter.Key Words: Persistent left superior vena cava, Coronary sinus atresia, Central venous catheter, Chemotherapy, Hematological malignancy     

Metastatic cancer. A relative contraindication to vena cava filter placement

From October 1979 to November 1984, 41 patients underwent placement of vena cava filters for prevention of pulmonary emboli. After filter placement, no pulmonary emboli were documented. No patient died due to filter placement. However, 20 of these 41 patients are dead. Eighteen deaths were caused by cancer. Ten (24%) patients died within 2 months of filter placement. Five (12%) patients died prior to hospital discharge. All ten of these patients had known, widely metastatic cancer. Among the ten patients who died more than 2 months after filter placement, six had well-differentiated, slow growing tumors. Only three of these patients had brain metastases. Among the 21 survivors only two suffered from cancer. Strict adherence to accepted indications for vena cava filter placement required operative procedures on a small but significant number of patients who demonstrated no significant improvement in quality of life or time out of hospital. Filter placement in patients with aggressive cancers and proven metastases should be performed only after analysis of predicted survival and after detailed discussions with patients and referring physicians. Filter placement in patients with aggressive metastatic cancer may cause discomfort, risk, and expense with little hope for improvement of hospital course, longevity, or quality of life.     

Inferior vena cava “birds nest” filters - 2 year follow-up

This study examines long term efficacy and saftey of “birds nest” filters (Cook), and the use of doppler ultrasound to assess patency. Of the seventeen “birds nest” filters inserted twelve were available for study. All patients were reviewed for evidence of recurrent pulmonary emboli or filter complication. Mean length of follow up was 10 months, (7 had follow up of > 12 months). Three have had further episodes of deep venous thrombosis, with probable recurrent pulmonary embolism in one. No patient had evidence of thrombosis of the inferior vena cava. No fracture or migration of the “birds nest” filters was found. Ten of the twelve filters studied with ultrasound could be visualized within the cava. In all, turbulent flow was detected with colour and duplex doppler study. We conclude that insertion and use of the “birds nest” filters is safe, with a high long term patency rate and few initial or long term complications. Doppler ultrasound is a simple and rapid method of assessing venous patency.     

Cyberknife治疗纵隔转移淋巴结的临床分析

  目的  评价射波刀(Cyberknife)治疗纵隔转移淋巴结的临床价值。  方法  分析射波刀治疗39例恶性肿瘤纵隔淋巴结转移患者的临床资料。病灶共计49个, 直径1.5~4.3 cm。治疗剂量12~60 Gy, 分割1~10次。  结果  治疗后随访3~67个月(中位数20个月), 胸闷、气短等症状缓解率83.3%。49个病灶CR、PR、SD分别为29、15、5个, 有效率90%。1、2年局控率为100%、91%, 1、2年生存率分别为84.6%、68.3%。急性期无反应者25例, 1~2级、3~4级放疗反应分别为11例、3例。既往行胸部放疗、隆突下及气管食管沟病灶、放疗前后1个月行化疗者放疗不良反应发生率较高(P=0.014、0.007、0.039), 反应组食管5 mL平均照射剂量30.62 Gy明显高于无反应组15.5 Gy(P=0.045)。  结论  射波刀为纵隔淋巴结转移者提供了安全有效的治疗手段。      

Management of venous thromboembolism in colorectal cancer patients treated with bevacizumab

Venous thromboembolism associated with use of a central venous access system is an urgent problem in patients treated with bevacizumab (bev). We investigated the effectiveness of Doppler ultrasound imaging (DUS) in the early detection of catheter-related thrombosis for avoidance of severe venous thromboembolism. Patients with metastatic colorectal cancer received either FOLFOX-4 + bev or FOLFIRI + bev. DUS was performed on the deep venous system for detection of thrombus formation during the initial cycle of treatment, followed by re-evaluation after the third cycle in patients with asymptomatic thrombus formation. All patients were followed up until treatment was interrupted. Median duration of follow-up was 484 days (range 72–574). Among 41 enrolled patients, curable symptomatic thrombosis occurred in one, and asymptomatic thrombosis in 21 (51.2%). Of 21 patients undergoing re-evaluation, thrombi remained without progression in 17 patients, and enlargement in 4 patients. In two of the patients in whom there was progression, pulmonary embolism occurred after the sixth cycle. In the asymptomatic group, no thrombi developed as far as the superior vena cava in any patient. In the cases of progression, thrombotic enlargement was observed in all the 4 patients, with decreased vascular flow in 2. Using DUS, we were able to detect asymptomatic thrombosis in the early cycles of treatment, indicating its potential in the monitoring of venous thrombi. In the event of an enlarging asymptomatic thrombosis developing into the superior vena cava along with decreased vascular flow, careful follow-up and appropriate anticoagulant therapy may be recommended without increased risk of bleeding.     

Iatrogenic superior vena cava syndrome. A new entity

Four patients with cancer developed superior vena cava syndrome following placement of a central venous catheter (Broviac or Hickman catheter) without evidence of mediastinal tumoral involvement. Diagnostic and therapeutic considerations are discussed.     

IVC filter limb penetration of the caval wall during retroperitoneal surgery/lymph node dissection

Optional inferior vena cava (IVC) filters are being increasingly used for protection against pulmonary embolism in patients with deep vein thrombosis where anticoagulation is contraindicated. We describe two cases during retroperitoneal surgery where the IVC filters were found to have perforated the cava wall and were subsequently removed intra‐operatively. Cava wall penetration by filter limbs poses a significant danger during retroperitoneal lymph node dissection and filters should be removed preoperatively.