肿瘤患者合并深静脉血栓的临床分析

目的:探讨恶性肿瘤并发血栓性疾病的危险因素,为及早预防提供依据.方法:收集30例恶性肿瘤并发血栓栓塞患者为病例组,并收集同期不伴有血栓栓塞的38例恶性肿瘤患者为对照组,回顾性分析恶性肿瘤并发血栓栓塞的危险因素.结果:病例组30例患者中,下肢深静脉血栓形成者24例,上肢深静脉血栓5例,肺栓塞者1例.观察组红细胞计数和血红蛋白值均低于对照组,血小板计数和D-二聚体高于对照组,差异均有统计学意义(P<0.05).恶性肿瘤并发血栓性疾病的发生在并发感染、接受手术、地塞米松治疗和中心静脉置管上存在差异(P<0.05).30例患者在肿瘤确诊2个月内并发血栓性疾病.结论:恶性肿瘤并发感染、地塞米松的应用、接受手术和中心静脉置管的应用时易并发血栓形成.     

恶性肿瘤并发血栓栓塞53例临床分析

目的探讨中晚期肿瘤患者并发血栓栓塞的相关因素、临床特点、诊断及治疗方法。方法以53例恶性肿瘤并发血栓栓塞患者为病例组,收集同期不伴有血栓栓塞的30例恶性肿瘤患者作为对照组,回顾性分析两组患者的临床资料,对栓塞部位、血小板、D-二聚体及纤维蛋白水平等进行分析。结果病例组53例患者中,下肢深静脉血栓27例,上肢深静脉血栓6例,肺栓塞13例,脑栓塞4例,门静脉栓塞2例,脾静脉栓塞1例,15例治愈,22例好转,总有效率为69.8%。结论恶性肿瘤临床分期晚、发生远处转移、D-二聚体水平升高、合并心脑血管疾病,与患者血栓栓塞的发生相关。     

晚期肿瘤患者深静脉血栓形成的危险因素分析

[目的]探讨晚期肿瘤患者发生深静脉血栓的危险因素.[方法]采用回顾性分析方法,对2005年1月至2010年12月期间发生深静脉血栓的78例晚期肿瘤患者的临床资料进行分析,同时随机选择同期不伴有血栓性疾病的78例恶性肿瘤患者为对照,分析晚期肿瘤患者深静脉血栓形成的危险因素.[结果]多因素分析显示,并发感染(OR=3.249,P=0.038)、输血(OR=1.460,P=0.041)及远处转移(OR=7.376,P＜0.001)是晚期肿瘤患者发生深静脉血栓的独立危险因素,病例组1年生存率明显低于对照组(41.0％ vs 52.6％,x2=4.991,P=0.025).[结论]远处转移、并发感染、输血治疗是晚期肿瘤患者发生深静脉血栓的危险因素,发生深静脉血栓者预后较差.     

恶性肿瘤合并血栓栓塞性疾病22例临床分析

[目的]探讨恶性肿瘤合并血栓栓塞性疾病的特点。[方法]回顾性分析22例经病理学证实的恶性肿瘤合并血栓栓塞性疾病患者的临床资料。[结果]22例恶性肿瘤合并血栓栓塞性疾病中,并发颈内静脉血栓形成4例,单纯下肢深静脉血栓形成（DVT）10例,单纯肺血栓栓塞（PTE）3例,DVT合并PTE5例。5例合并PTE患者中3例有较典型的临床症状,多有低氧血症、血D-二聚体明显升高。心电图仅1例有典型SIQIIITIII表现。[结论]恶性肿瘤并发血栓栓塞性疾病临床常见,对手术、化疗、放疗、PICC置管或疾病进展可能导致血液高凝状态患者应及早进行抗凝治疗,预防血栓栓塞性疾病的发生。     

妇科肿瘤围手术期并发血栓性疾病30例的临床分析

目的：探讨妇科肿瘤患者围手术期并发血栓性疾病的诊疗措施及相关因素。方法回顾性分析30例妇科肿瘤围手术期并发血栓性疾病患者的临床特征、诊治过程,并根据相关因素提出针对性的预防措施。结果29例深静脉血栓（ DVT）患者给予溶栓、抗凝及祛聚治疗后,28例痊愈,1例左侧下肢伴有轻微下肢功能障碍。1例肺栓塞（ PTE）患者转入心内科治疗后痊愈。大龄女性、静脉血栓史、合并慢性病、恶性肿瘤、术后服用止血药及雌激素、盆腔淋巴结清扫术是妇科肿瘤患者术后并发血栓性疾病的可能危险因素。结论手术前后积极预防,充分评估,早期诊断,及时治疗,可降低妇科肿瘤围手术期血栓性疾病发生的危险,改善并发PTE患者的预后。     

恶性肿瘤并发急性下肢深静脉血栓形成的疗效分析

目的探讨溶栓、抗凝等常规疗法对恶性肿瘤并发的急性下肢深静脉血栓形成（DVT）的疗效。方法34例恶性肿瘤并发的DVT患者为观察组,选择34例创伤或手术后并发的DVT患者为对照组,两组均给予溶栓、抗凝等常规治疗,比较两组下肢深静脉再通情况和疗效。结果观察组下肢深静脉再通率、有效率均低于对照组（P〈0．05）。结论常规疗法对恶性肿瘤并发的急性下肢深静脉血栓形成的疗效较差。     

恶性肿瘤患者合并深静脉血栓的护理观察

早在1865年Trousseau已经注意到胃癌患易发生四肢深静脉血栓,现在血栓栓塞症（venous thromboembolism,VEF）已被认为是恶性肿瘤患的一个重要死因。深静脉血栓（deep venous thrombosis,DVT）是肿瘤患中最常见的血栓栓塞性疾病,现收集我科诊治的26例恶性肿瘤合并DVT的患,结合其临床表现、诊断和护理特点报告如下。     

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。     

宫颈癌合并深静脉血栓30例临床分析

目的：静脉血栓栓塞症（VTE）是恶性肿瘤患者常见并发症。本文结合文献分析我院住院病人宫颈癌患者静脉血栓的临床特征,分析VTE形成机制及诱发因素,探索最佳治疗方法。方法：对近5年我科收治的宫颈癌合并深静脉血栓30例患者的临床资料进行分析。结果：30例患者中17例VTE的发生和介入手术化疗有关。2例（6.7%）血栓栓塞发生在宫颈癌确诊之前,28例（93.3%）发生在宫颈癌确诊之后,单纯并发下肢深静脉血栓形成（DVT）27例,合并肺栓塞（PTE）2例,DVT合并PTE 1例。22例在栓塞前有化疗史。结论：血栓可能为肿瘤病人的首发表现,病人出现不能解释的血栓栓塞性疾病应考虑有肿瘤的可能。抗凝治疗对于血栓栓塞症疗效确切。及时诊断和治疗可以延长患者的生存期,降低患者的死亡率。口服避孕药、口服甲地孕酮、介入手术与VTE的发生几率可能有关。分期晚,远地转移的肿瘤患者易出现血栓栓塞。     

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。     

Breast cancer as an acquired thrombophilic state

Cancer is an acquired thrombophilic condition manifested by increased incidence of venous and arterial thromboembolic complications. Despite progress that has been achieved in treatments over the recent years, thromboembolism remains a major complication in patients with breast cancer; it is accompanied by significant morbidity and mortality. Approximately, 1% of breast cancer patients develop venous thromboembolism within 2 years with the highest incidence occurring in the 6 months post diagnosis. Metastatic disease and their comorbidities are the strongest predictors of the development of thrombotic event. The diagnosis of venous thromboembolism is associated with a higher risk of death within 2 years of diagnosis. Thromboembolic events in cancer patients range from abnormal laboratory coagulation tests without specific symptoms to massive thomboembolism and disseminated intravascular coagulation. The underlying pathophysiology is complex and includes the prothrombotic properties of cancer cells, which can be enhanced by anticancer treatment modalities, such as surgery, hormonal agents, and chemotherapy. Primary thromboprophylaxis in cancer patients should be individualized according to risk. For secondary prevention, several clinical studies have shown that low molecular weight heparin has improved patients' compliance, cancer outcomes and overall survival. This review summarizes the available data on the pathogenesis and clinical approach of hemostatic changes in breast cancer.     

肺癌患者手术前后凝血状态的变化

背景与目的恶性肿瘤可引起机体高凝血状态,可能导致血栓栓塞症的发生,手术创伤则是重要的危险因素。本研究探讨肺癌患者手术前后凝血状态、变化及临床意义。方法采用前瞻性对照研究方法,选取普胸外科临床有效病例74例,分为肺癌组和肺良性疾病组。观察患者术前和术后凝血酶原时间(prothrombin time,PT)、活化的部分凝血活酶时间(activated partial thromboplastin time,APTT)、血小板计数(platelet count,PLT)、D二聚体(D-dimer,D-D)及纤维蛋白原(fibrinogen,Fib)等指标反应的凝血功能状态、变化及临床表现,比较组间组内之间的差别。结果术前肺癌组较肺良性疾病组患者以及肺癌类型中腺癌患者较鳞癌患者术前Fib升高并高于正常值(P<0.05)。肺癌组患者出现PT在术后第1天-第7天延长,APTT在术后第3天-第7天缩短,Fib在术后第3天-第7天、D-D在术后第1天-第7天升高,PLT在术后第1天、第3天较术前呈下降趋势而术后第5天、第7天有升高趋势,与术前比较差异有统计学意义(P<0.05)。肺癌组较肺良性疾病组患者术后第7天PT、D-D...     

Ischemic heart disease precipitated by occult cancer.

The hypothesis was tested that cancer, by virtue of it being a thrombotic diathesis, may enhance ischemic heart disease. Because cancer therapy may precipitate thromboembolism, the authors focused on patients with occult neoplasia before therapy. Occult cancer was defined as a time period of 2 years before a cancer diagnosis was established. Data obtained from the files of patients with the diagnosis of malignant tumors and admitted to a general hospital during a 3-year period were reviewed for coronary risk factors, coronary events, and characteristics of cancer. Indices of coronary instability were studied: the incidence of first coronary events, the incidence of all coronary events, and the coronary events burden. These indices were calculated for 366 patients with cancer (from the Department of Medicine files of 166 consecutive patients with cancer of several primary sites and from the surgical ward files of 100 consecutive patients with colorectal cancer and 100 consecutive patients with cancer of the prostate or bladder) and for 100 patients with benign prostatic hypertrophy. The patients with benign prostatic hypertrophy served as controls. A steep and statistically significant increase in coronary instability indices was observed in all groups of patients with cancer in the 2-year period before cancer diagnosis in comparison with the coronary instability indices of control patients (P less than or equal to 0.05 to 0.0001). Patients with colorectal cancer presented the highest indices in the 2-year period before cancer diagnosis, with unstable ischemic heart disease being reported in 18% and first coronary events in 10%. The coronary events burden was 0.92. The lowest indices among patients with cancer were recorded in those with prostatic and bladder cancer. Unstable ischemic heart disease occurred in 6% and first coronary events in 4%. The coronary events burden was 0.36. The indices were several times lower for control patients than for patients with cancer. Unstable ischemic heart disease occurred in 3% of control patients, and first coronary events in 2%. The coronary events burden was 0.15. Other possible etiologic factors, particularly the known coronary risk factors and anemia, were not statistically related with an increased risk of coronary events in the 2-year period before cancer diagnosis. Based on these epidemiologic data, it appears that there may be an association between occult cancer and coronary events.     

晚期肺癌化疗患者伴静脉血栓栓塞症的相关因素分析

目的：分析晚期肺癌化疗患者伴静脉血栓栓塞症的相关因素。方法回顾性分析晚期肺癌化疗伴静脉血栓栓塞症的53例患者（栓塞组）和晚期肺癌化疗未伴有静脉血栓栓塞症的60例患者（对照组）的临床资料,并对晚期肺癌化疗患者伴静脉血栓栓塞症发生的影响因素进行Logistic回归分析。结果单因素分析表明两组患者的性别、病理分型、高脂血症、高血压、肥胖、糖尿病及血小板计数上升比较,差异均无统计学意义（P﹥0.05）;两组患者的年龄、临床分期、吸烟史、D-二聚体上升及血黏稠度升高比较,差异均有统计学意义（P﹤0.05）。通过对筛选出的影响因素予以多因素Logistic回归分析发现,年龄≥60岁、吸烟史、临床分期为Ⅳ期、D-二聚体上升及血黏稠度升高属于晚期肺癌化疗患者伴有静脉血栓栓塞症的危险因素。结论年龄≥60岁、吸烟史、临床分期为Ⅳ期、D-二聚体上升及血黏稠度升高作为晚期肺癌化疗患者伴有静脉血栓栓塞症的危险因素,在临床中,应加以重视。     

The risk of a second cancer after hospitalisation for venous thromboembolism

Although venous thromboembolism (VTE) is common in patients with cancer, it is not known if it is associated with risk of a second malignancy. Using the Danish Cancer Registry and National Registry of Patients, we studied a population-based cohort of 6285 patients with cancer who had an episode of VTE. The risk of a second cancer was compared with that among 30 713 cancer patients without VTE, matched for age, sex, cancer site and year of diagnosis. Overall, the relative risk for a second cancer diagnosis was 1.3 (95% confidence interval (CI) 1.1-1.4). However, the excess risk varied with the time from the initial cancer diagnosis to the thrombotic event. If the thrombotic episode occurred within the first year, the relative risk for a second cancer was 1.0 (95% CI 0.9-1.3), but if the VTE occurred more than 1 year after the initial cancer, the overall relative risk for a second cancer was 1.4 (95% CI 1.2-1.7), with strong associations for cancers of the digestive organs, ovary and prostate. The association between VTE and subsequent incident cancer extends to patients who already have had a cancer diagnosis.     

Characteristics and outcomes of cancer patients who develop pulmonary embolism: A cross-sectional study

Pulmonary embolism (PE), along with deep vein thrombosis, are collectively known as venous thromboembolism (VTE). Predisposing factors for PE include post-operative conditions, pregnancy, cancer and an advanced age; of note, a number of genetic mutations have been found to be associated with an increased risk of PE. The association between cancer and VTE is well-established, and cancer patients present a higher risk of a thrombotic event compared to the general population. In addition, PE is a significant cause of morbidity and mortality among cancer patients. The aim of the present study was to illustrate the clinical characteristics, laboratory findings, radiology features and outcomes of cancer patients who developed PE, collected from an anticancer hospital. For this purpose, adult cancer patients diagnosed with PE by imaging with computed tomography pulmonary angiography were enrolled. The following data were recorded: Demographics, comorbidities, type of cancer, time interval between cancer diagnosis and PE occurrence, the type of therapy received and the presence of metastases, clinical signs and symptoms, predisposing factors for PE development, laboratory data, radiological findings, electrocardiography findings, and the type of therapy received for PE and outcomes in a follow-up period of 6 months. In total, 60 cancer patients were enrolled. The majority of the cancer patients were males. The most common type of cancer observed was lung cancer. The majority of cases of PE occurred within the first year from the time of cancer diagnosis, while the majority of patients had already developed metastases. In addition, the majority of cancer patients had received chemotherapy over the past month, while they were not receiving anticoagulants and had central obstruction. A large proportion of patients had asymptomatic PE. The in-hospital mortality rate was 13.3% and no relapse or mortality were observed during the follow-up period. The present study demonstrates that elevated levels of lactic acid and an increased platelet count, as well as low serum levels of carcinoembryonic antigen, albumin and D-dimer, may be potential biomarkers for asymptomatic PE among cancer patients.     

15例以消化道症状首发肺癌的误诊分析

目的 探讨以消化道症状为首发表现肺癌的临床特点和误诊情况,以提高对本病的认识。方法 回顾性分析2005年1月至2013年1月收治的15例以消化道症状为首发表现肺癌患者的临床资料。结果 15例以消化道症状为首发表现的肺癌患者中,恶心、呕吐7例,纳差、消瘦3例,进食哽噎2例,上腹痛2例,腹泻1例;其中9例合并顽固性低钠血症。误诊为急性胃炎7例,慢性胃炎3例,食管炎2例,消化性溃疡1例,胆石症1例,急性肠炎1例。确诊为小细胞肺癌8例,其中7例伴抗利尿激素异常分泌综合征（SIADH）,1例伴类癌综合征;肺鳞癌2例,伴纵隔淋巴结转移;肺腺癌5例,其中2例伴锁骨上淋巴结转移,2例伴SIADH,1例伴脑转移。结论 以消化道症状首发的肺癌临床上易误诊,临床医师要提高对此类情况认识,严谨检诊。