儿童恶性肿瘤相关性血栓形成(附11例报告)

目的:通过病例分析，提高对儿童恶性肿瘤相关性血栓形成的认识，减少血栓形成及栓塞风险。方法:回顾分析2013年1月至2020年6月在本院儿童血液与肿瘤科住院的恶性肿瘤患儿合并血栓形成的临床资料，分析其影响因素、临床表现、诊断、治疗与转归。结果:血栓形成率:2013年1月-2020年6月，共收治恶性肿瘤患儿727例，相关性血栓形成11例（1.51%）。肿瘤类型与血栓部位:急性淋巴细胞白血病（ALL）6例（54.55%）；静脉血栓形成10例（90.9%）。经外周中心静脉置管（PICC）相关:7例（63.64%）血栓发生在导管相关部位。化疗与感染:有3例（27.27%）患儿应用培门冬酶合并重症感染。临床表现与影像学诊断:动脉血栓表现为皮肤发凉、苍白，变黑，远端动脉搏动消失。静脉血栓表现为肢体肿胀，伴或不伴疼痛、活动受限。11例患儿出现症状后均经过血管B超明确诊断。治疗与转归:经过低分子肝素钠治疗后7例血栓完全消除，3例血栓部分消除，1例截肢，无1例血栓栓塞发生。结论:儿童恶性肿瘤相关性血栓形成发生率低，一旦发生，后果严重。儿童恶性肿瘤相关性血栓形成与肿瘤类型、治疗阶段、PICC应用、培门冬酶、感染等多个因素相关，发生在导管相关部位多见。临床表现以静脉血栓形成多见，表现为肢体肿胀、或伴有疼痛、活动受限。B超诊断方便快捷，低分子肝素治疗有效。

Malignant tumor associated thrombosis in children:A report of 11 cases

Objective:Through case analysis,to improve the understanding of malignant tumor related thrombosis in children and reduce the risk of thrombosis and embolism.Methods:The clinical data of thrombosis in children with malignant tumors hospitalized in the Department of Hematology and Oncology of our hospital from January 2013 to June 2020 were retrospectively analyzed,and the influencing factors,clinical manifestations,diagnosis,treatment and outcome were analyzed.Results:Thrombosis rate:From January 2013 to June 2020,727 children with malignant tumor were treated,and 11 cases (1.51%) were associated with thrombosis.Tumor type and thrombus location:Acute lymphoblastic leukemia in 6 cases (54.55%),venous thrombosis in 10 cases (90.9%).PICC related:7 cases (63.64%) of thrombosis occurred in the catheter related site.Chemotherapy and infection:There were 3 cases (27.27%) with severe infection.Clinical manifestations and imaging diagnosis:Arterial thrombosis showed cool,pale,blackened skin,and disappearance of distal arterial pulsation.Venous thrombosis was characterized by limb swelling,with or without pain and limited movement.All the 11 cases were diagnosed by B-ultrasound.Treatment and outcome:After low molecular weight heparin sodium treatment,7 cases of thrombosis were completely eliminated,3 cases of partial elimination of thrombosis,1 case of amputation,no thromboembolism occurred.Conclusion:The incidence of malignant tumor associated thrombosis in children is low,once it occurs,the consequences are serious.Malignant tumor related thrombosis in children is related to tumor type,treatment stage,application of PICC,pegaspartic enzyme,infection and other factors.Venous thrombosis is the most common clinical manifestation,with limb swelling,pain and activity limitation.B ultrasound diagnosis is convenient and fast.Low molecular weight heparin treatment is effective.