输液港无症状导管深静脉血栓抗凝治疗的临床研究

Necessity of anticoagulant therapy for asymptomatic deep venous thrombosis related to totally implantable venous access port

目的探讨输液港无症状导管相关深静脉血栓形成后抗凝治疗的必要性。方法回顾性分析2014年11月—2016年12月于重庆医科大学附属第一医院血管外科会诊的输液港无症状深静脉血栓形成患者的年龄、D-二聚体水平、输液港保留时间、超声结果、抗凝方案、并发症及随访情况。结果化疗结束前仅1例患者提前移除输液港,其他患者无并发导管相关血流感染或症状性肺栓塞,抗凝治疗期间无出血事件。CR-DVT缓解与年龄、CRT诊断时D-二聚体的水平、计划移除输液港时D-二聚体的水平、输液港植入到血栓发作的时间间隔、输液港保留时间均无相关性(P>0.05)。结论输液港无症状深静脉血栓形成后抗凝治疗并无明显获益,需要更大规模的研究来明确这种类型的血栓是导管植入后的生理反应还是需要治疗的病理状态。

Objective To evaluate the necessity of anticoagulant therapy for totally implantable venous access port(TIVAP)-related asymptomatic deep venous thrombosis.Methods A retrospective analysis was performed for the patients with breast cancer receiving TIVAP who had detected nonocclusive,asymptomatic catheter related deep venous thrombosis(CR-DVT)and consultation in Department of Vascular Surgery,the First Affiliated Hospital of Chongqing Medical University from November 2014 to December 2016.The patients’age,D-dimer level,the time that TIVAP was implanted in the body,treatment methods,ultrasonographic results,complications and followup results were analyzed.Results Only one TIVAP was removed before the end of all chemotherapy courses for catheter dysfunction.No concurrent infection or symptomatic pulmonary thromboembolism occurred.No bleeding event was reported during the anticoagulant therapy.Remission of CR-DVT seemed to have no correlation with age,the D-dimer levels at diagnosis and at the time of planned removal of infusion port,the time interval from TIVAP insertion to thrombosis onset,or the duration of TIVAP retention in the body(P>0.05).Conclusions Anticoagulant therapy to these small,nonocclusive,asymptomatic TIVAP-related DVT does not show clear benefit.More researches are needed to figure out whether the asymptomatic CR-DVT is a physiological response for catheter implantation or a pathological state needing treatment.