以下肢深静脉血栓形成为最初临床表现的恶性肿瘤病例分析

Deep venous thrombosis of the lower extremities as initial clinical symptom of malignance

目的分析以下肢深静脉血栓形成为主要临床表现的恶性肿瘤患者的临床特点。方法从2010年5月至2012年1月对下肢深静脉血栓形成的患者进行肿瘤筛查，分析肿瘤筛查阳性患者的年龄，性别，血栓形成部位，肺栓塞的发生，癌症标志物、临床症状特点等，并与肿瘤筛查阴性患者进行比较。结果本组入选接受肿瘤筛查84例患者，均为无明显相关危险因素的下肢深静脉血栓形成患者。男43例，女41例。平均年龄（62±16）岁。共发现恶性肿瘤8例，占9．52％。其中肺癌3例，胰头癌1例，软组织肉瘤1例，卵巢癌1例，结肠癌1例，子宫颈癌1例。恶性肿瘤组患者平均年龄（51±25）岁，筛查阴性组平均年龄（64±15）岁，2组差异无统计意义（t=1．92，P=0．18）。恶性肿瘤患者组中央型深静脉血栓形成比例为100％，高于筛查阴性组的63．17％（X2=4．42，P=0．047）。肿瘤筛查阳性组血清肿瘤标志物阳性率为62．5％，高于筛查阴性患者的10．53％（X2=14．95，P=0．002）。恶性肿瘤组CTA检查发现肺栓塞5例，均为次大面积肺栓塞，发生率为62．5％，高于肿瘤筛查阴性组18．4％（X2=8．04，P=0．01）。发现肿瘤后中位生存时间为6个月。结论以下肢深静脉血栓形成为最初临床主要表现的恶性肿瘤患者的特点为大多为近心端深静脉血栓，肺栓塞比例高，腺癌多见。

Objectives To study the characteristics of malignance patients with initial presentation of deep venous thrombosis （DVT） of the lower limb. Methods This study screened neoplasm among patients with deep venous thrombosis between May 2010 and January, 2012. The characteristics of location of deep venous thrombosis, incidence of pulmonary embolism, serum tumor marker, gender, ages were evaluated. Results 84 DVT patients were recruited, including 43 male and 41 males. Malignant neoplasms were detected in 8 patients with incidence of 9. 52%, including lung cancer in 3 patients, pancreas cancer, soft tissue sarcoma, ovarian cyst carcinoma, cervical cancer, and colon cancer in one each patient. Proximal deep venous thrombosis presented in all patients with malignant neoplasm. Positive rate of serum biomaker was 62. 5% in neoplasm group which was higher than that of 10. 53% in screen negative group （ P = 0. 002 ）. Sub-massive pulmonary embolism was detected by computer tomography angiography in 5 patients in malignant neoplasm group （62. 5% ） ,whieh is higher than that of 18.40% in screen negative patients （ P = 0. 01 ）. Median lifetime of patients with neoplasm after diagnosis was 6 months. Conclusions Most patients with DVT malignant neoplasm were of adenocarcinoma and often suffered from pulmonary embolism.