恶性肿瘤合并静脉血栓栓塞107例临床分析

Clinical analysis on 107 cases of malignant tumor with venous thromboembolism

目的探讨恶性肿瘤合并静脉血栓栓塞(VTE)患者的临床特征,为恶性肿瘤合并VTE的早期预防及诊治提供临床依据。方法对我院2009年6月至2011年6月收治的107例恶性肿瘤合并静脉血栓患者的临床资料进行回顾性研究。结果 107例恶性肿瘤合并VTE患者中,单纯深静脉血栓(DVT)90例(84.1%);肺血栓栓塞症(PTE)17例(15.9%),其中合并DVT 7例(6.5%,7/107)。平均年龄(59.6±10.5)岁,≥60岁63例(58.9%)。Ⅲ～Ⅳ期恶性肿瘤61例(57.0%)。69例(64.5%)VTE发生于恶性肿瘤诊断后3个月内,43例(40.2%)VTE发生于手术后1个月内,其中术后1～7天30例(28.0%)。91例DVT患者中84例接受抗凝治疗,49例治疗后好转,有效率为58.3%(49/84)。PTE患者溶栓联合抗凝治疗2例,1例治疗后明显好转,1例好转;单纯抗凝治疗12例,3例明显好转,6例好转,3例无效。本组PTE患者抗凝溶栓治疗的有效率78.6%(11/14),病死率29.4%(5/17)。结论恶性肿瘤诊断后3个月内、手术后1个月尤其是1周内,Ⅲ～Ⅳ期、≥60岁的患者高发VTE。VTE(尤其是PTE)可以增加恶性肿瘤患者的病死率,影响其预后。对于恶性肿瘤合并VTE患者的早期诊断与治疗是降低病死率及改善预后的关键。

Objective To discuss the clinical features of malignant tumor accompanied with venous thromboembolism（VTE）, which may provide the clinical evidence for prevention, diagnosis and treatment of this disease. Methods We retrospectively reviewed the clinical data of patients with malignant tumor who were diagnosed with VTE between June 2009 and June 2011 in our hospital. Results Among 107 cases with VTE, 97 cases（84.1%） were deep venous thrombosis （DVT）, 17 cases （ 15.9 % ） were pulmonary thromboembolism （PTE）, in which 7 cases were complicated with both DVT and PTE, 6.5% （7/107）. The average age was（59.6± 10.5） years old. 63 cases （58.9%） were older than 60 years old. 61 cases（57.0%） were diagnosed with Ill-IV tumor stage. 69 eases（64.5%） with VTE occurrence in 3 months after the diagnosis of tumors. 43 eases（40.20/00） with VTE occurrence in one month after surgery,containing 30 cases（28.0%） occurrence in 1-7 days after surgery. Among 91 cases with DVT, 84 cases accepted anticoagulation therapy,49 cases proved effective, the effective rate was 58.3 % （49/84）. Among 2 cases with PTE who accepted both thrombolysis and anticoagulation therapy, 1 case was notably effective, 1 case was effective; Among 12 cases with PTE who accepted anticoagu[ation therapy, 3 cases were notably effective, 6 cases were effective, 3 cases were ineffective. The effective rate of anticoagulation and/or thrombolytic therapy of PTE was 78.6 % （11/14）, the mortality was 29.4% （5/17）. Conclusion The time within three months after the diagnosis of malignant tumor and the first month especially the first week after surgery is the high risk time of VTE occurrence, and patients with advanced tumor stages,older than 60 years old, VTE occurred more frequently. VTE,especially PTE, can increase the mortality of patients with malignant tumor and influence the prognosis. Early diagnosis and treatment is the key to reduce mortality and improve prognosis of malignant tumor with VTE.