恶性肿瘤合并肺栓塞60例临床分析

目的 提高对恶性肿瘤合并肺血栓栓塞症(PTE)临床特点的认识.方法 对2005年1月至2008年7月北京协和医院60例恶性肿瘤合并PTE患者进行回顾性临床分析.结果 恶性肿瘤分布在呼吸系统(36.7%)、消化系统(26.7%)、泌尿生殖系统(10.O%)、血液系统(8.3%)和神经系统(5.0%)等,以肺(30.O%)、胃(8.3%)、胰腺(6.7%)、肝脏(5.O%)等脏器多见.18例肺癌中,12例(66.7%)为腺癌.47例(78.3%)为进展期肿瘤.30例(50.0%)合并深静脉血栓形成(DVT),其中上肢3例(10.0%),下肢24例(80.0%),其他部位5例(16.7%,有2例并存上下肢DVT).有2例(3.3%)合并股动脉栓塞.PTE发生于肿瘤确诊前(平均5.5个月)5例(8.3%).PTE发生于肿瘤围手术期22例,其中17例(77.3%)发生于术后2周.15例(25.0%)PIE患者无明显症状,49例(84.5%)患者动脉氧分压降低.死亡13例(21.7%),其中6例猝死;恶化8例(13.3%);好转39例(65.0%).结论 PTE是恶性肿瘤患者常见的并发症和致死原因之一,最常见于肺癌,尤其是肺腺癌.PTE常合并有DVT,以下肢多见.FIE好发于老年人、肿瘤进展期及围手术期,与长期卧床、化疗、中心静脉置管等因素相关.肿瘤患者术后2周内的FIE发生率高,临床表现可不典型.静脉血栓栓塞症(VTE)有可能为恶性肿瘤的首发信号,不明原因的FIE和(或)DVT应警惕潜在恶性肿瘤的可能.

Pulmonary embolism in cancer: clinical analysis of 60 cases

Objective To enhance the understanding of pulmonary thromboembolism (PTE) in patients with cancer. Methods from January 2005 to July 2008, sixty patients diagnosed as pulmonary thromboembolism in Peking Union Medical College Hospital were retrospectively reviewed. Results The primary cancers were from respiratory system (36.7%), digestive system (26.7%), urogenital system (10.0%), hematological system (8.3%) and nervous system (5.0%), respectively, especially from such organ as lung (30.0%),stomach (8.3%), pancreas (6.7%), liver (5.0%) and so on. 12 of 18 patients (66.7%) with lung cancer were adenocarcinoma. There were 47 patients (78.3%) with advanced cancer. Deep venous thrombosis (DVT) occurred in 30 patients (50.0%). Of them 24 patients (80.0%) occurred in the lower limb, and 3 patients (10%) in the upper limb, 5 patients (16.7%) in other sites including 2 cases with thrombi in both upper and lower limbs, respectively. There were 2 patients (3.3%) accompanied with femoral artery embolism. PTE before tumor diagnosed occurred in 5 patients (8.3%) with an average time of 5.5 months. 22 patients underwent cancer-related operation and 17 patients (77.3%) had PTE in the later 2 weeks. 15 patients (25.0%) showed no symptoms. Arterial oxygen partial pressure was reduced in 49 patients (84.5%). 13 patients (21.7%) died and 6 cases of them were sudden death. 8 patients (13.3%) aggravated. 39 patients (65. 0%) improved. Conclusion PTE is one of the major complications and leading causes of death in patients with cancer. Of which lung cancer is most commonly, pulmonary adenocarcinoma in particular. PTE is often accompanied by DVT in the lower extremity. Risk factors may be old age, cancer progression and cancer-related operation. Other factors include long time in bed, chemotherapy and central vein catheterization, and so on. It should be watchful of PTE in cancer patients undergoing operation, especially within the first two postoperative weeks. Its clinical manifestation is often atypical. Sometimes venous thromboembolism(VTE) is the first signal of malignancy. In patients with unexplained PTE and/or DVT, attention should be paid to the possibility of malignancy. The first choice of anticoagulants is low molecular weight heparin.