以静脉血栓为首发临床表现的恶性肿瘤73例

Malignant tumors with venous thrombosis as the first clinical manifestation: a study of 73 cases

目的探讨以静脉血栓为首发临床表现的恶性肿瘤患者的临床特点和生化指标,以期促进对恶性肿瘤的早期诊断和早期治疗。方法回顾性分析2002年1月至2017年11月山西省人民医院收治的73例以静脉血栓为首发临床表现来诊患者的临床资料,患者入院后均进行了静脉血栓形成的明确诊断,并通过全面的病史询问、体格检查、基本实验室检查、年龄和性别相关的特异性癌症筛查、更强化的癌症筛查方法,最终均在住院期间经病理学确诊为实体恶性肿瘤,对其临床资料进行汇总分析。结果 73例患者均经病理学确诊为恶性肿瘤,其中消化系统肿瘤28例,颈胸部肿瘤15例,泌尿系统肿瘤10例,妇科肿瘤8例,间叶组织肿瘤3例,血液系统肿瘤4例,不明原发肿瘤的转移癌5例,以消化系统占比最高(38. 4%)。73例患者中,以男性更多,占57. 5%;以≥50岁者更多,占67. 1%。所有患者的白蛋白和胆碱酯酶水平显著低于正常参考值(P均<0. 01),D-二聚体水平显著高于正常参考值(P <0. 01)。结论在临床如遇不明原因的静脉血栓形成患者,尤其是男性、年龄≥50岁、左下肢深静脉血栓形成、白蛋白和胆碱酯酶水平明显减低、D-二聚体水平明显增高者,应高度警惕恶性肿瘤的可能性。

Objective To investigate the clinical characteristics and biochemical indexes of malignant tumor patients with venous thrombosis as the first clinical manifestation,in order to promote the early diagnosis and treatment of malignant tumors. Methods The clinical data of 73 patients with venous thrombosis as the first clinical manifestation who received diagnosis and treatment in Shanxi Privincial People’ s Hospital from January 2002 to November 2017 were analyzed retrospectively. After admission,the patients were diagnosed with venous thrombosis,and through comprehensive medical history inquiry,physical examination,basic laboratory examination,age-and gender-specific cancer screening,and more intensive cancer screening methods,all of them were finally confirmed as solid malignant tumor by pathology during hospitalization,and their clinical data were analyzed. Results All the 73 patients were diagnosed as malignant tumor by pathology,including 28 cases of digestive system tumor,15 cases of neck and chest tumor,10 cases of urinary system tumor,8 cases of gynecological tumor,3 cases of mesenchymal tissue tumor,4 cases of hematological system tumor,5 cases of metastasis of unknown primary tumor,with the highest proportion of digestive system( 38. 4%). Among the 73 patients,57. 5% were male,and 67. 1% were over 50 years old. The level of albumin and cholinesterase in all patients was significantly lower than the normal reference values( all P < 0. 01),and the level of D-dimer was significantly higher than the normal reference value( P < 0. 01). Conclusion In the clinic,if there are patients with unknown causes of venous thrombosis,especially men,age ≥ 50 years old,deep venous thrombosis of the left lower extremity,significantly lower levels of albumin and cholinesterase,and significantly higher levels of D-dimer,we should be highly alert to the possibility of malignant tumors.