90例肺癌合并下肢静脉血栓形成的临床特征分析

Characteristics of lung cancer-associated lower limb venous thrombosis:A retrospective analysis of 90 cases

目的探讨肺癌合并下肢静脉血栓形成患者的临床特点及发病情况。方法回顾性分析我院2008年8月-2014年11月90例肺癌合并下肢静脉血栓形成患者的临床资料,分析其临床特点、治疗情况及发病情况。结果 90例中男性54例,女性36例,年龄28～85(59.9±12.6)岁。肺腺癌74例(82.2%),病理分期Ⅳ期66例(73.3%);有病理组织分化结果 69例(76.7%),其中中低分化占97.1%(67/69)。21例(23.3%)血栓发生于肿瘤确诊前,69例(76.7%)血栓发生于肺癌确诊后,其1个月、3个月、6个月、9个月、12个月血栓累计发生率分别为47.8%、68.1%、71.0%、75.4%、81.2%。手术后1个月、3个月、6个月、9个月、12个月血栓累计发生率分别为35.0%、50.0%、55.0%、55.0%、55.0%,化疗后分别为41.4%、51.7%、51.7%、55.2%、62.1%,放疗后分别为10.5%、26.3%、47.4%、57.9%、63.2%。经低分子肝素(low-molecular-weight heparin,LMWH)、华法林抗凝治疗74例(82.2%);好转出院65例(72.2%)。结论本组肺癌合并下肢静脉血栓形成患者主要的病理类型是肺腺癌,大部分是肺癌晚期,血栓多发生于肺癌确诊后及抗肿瘤治疗后3～6个月。大部分患者接受抗凝治疗,预后较好。

Objective To explore the clinical characteristics and occurrences of lower limb venous thrombosis in patients with lung cancer. Methods Clinical data about 90 lung cancer patients with lower limb venous thrombosis from August 2008 to November 2014 in our hospital were retrospectively analyzed. Their clinical characteristics, treatment and occurences were recorded. Results Of the 90 patients, there were 54 males and 36 females with average age of（59.9±12.6） years（range, 28 to 85 years）. Adenocacinoma was identified in 74（82.2%） patients and 66（73.3%） patients were in stageⅣ. Of the 69（76.7%） patients with histodifferentiation results, 97.1%（67/69） were moderately and/or low differentiated. Thrombosis was diagnosed before lung cancer in 21（23.3%） cases and after lung cancer in 69（76.7%） patients. After a definite diagnosis of lung cancer, 47.8%, 68.1%, 71.0%, 75.4% and 81.2% of patients experienced a thrombosis event within 1, 3, 6, 9 and 12 months respectively. After surgery, the incidences were 35.0%, 50.0%, 55.0%, 55.0% and 55.0% within 1, 3, 6, 9 and 12 months, after chemotherapy, they were 41.4%, 51.7%, 51.7%, 55.2% and 62.1%, respectively, and 10.5%, 26.3%, 47.4%, 57.9% and 63.2%, respectively after radiotherapy. Seventy-four（82.2%） patients received anticoagulant therapy with low-molecular-weight heparin（LMWH） and warfarin. Sixty-five（72.2%） patients improved when they were discharged. Conclusion In the group of lung cancer patients with lower limb venous thrombosis, adenocacinoma is the major histological type and most patients are diagnosed in late stage. The risk of venous thrombosis is highest in the first 3-6 months after lung cancer diagnosis or anti-tumor therapy. Most patients have received anticoagulation therapy and the prognosis is good.