晚期卵巢癌患者肺栓塞猝死临床病理讨论

Clinicopathological Conference:an Advanced Ovarian Carcinoma Patient Suddenly Died of Pulmonary Embolism

患者60岁,腹部胀痛1个月,开腹手术诊断为卵巢透明细胞癌Ⅲc期,G2。在满意的肿瘤细胞减灭术后,辅以紫杉醇和卡铂联合周疗。第Ⅰ疗程后,发生脑梗死。第Ⅲ疗程后出现呼吸困难,休息可缓解;3d后夜间活动突然呼吸困难,死于呼吸循环衰竭。尸检:卵巢透明细胞癌盆腹腔广泛转移,巨块型肺动脉血栓栓塞(血栓长20cm),脑梗死。妇科恶性肿瘤患者在围手术期和化疗过程中属于静脉血栓形成和肺栓塞的危险人群,应该适当给予预防性抗凝治疗。

A60year-old female complained with abdominal distension for one month.StageⅢc,grade2clear cell carcinoma of the ovary was diagnosed after laparotomy.Weekly paclitaxel combined with carboplatin as adjuvant chemotherapy was given after optimal cytoreductive surgery.An acute cerebral infarction after first chemotherapy cycle was developed.The patient presented with dyspnoea after the third chemotherapy cycle and the symptom could be relieved at rest.Such symptom worsened and relieved alternatively for3days.A sudden dyspnoea occurred to the patient again when she got up one night,an d died of respiratory and circulatory failure on the way to the hospital.Autopsy revealed ovarian clear cell carcinoma with metastasis to the whole pelvic and abdominal cavity and massive pulmonary arterial embolism(the length of embolus is20cm)with cerebral infarction.A conclusive remarks was made during the conference that patients who underwent operation and chemotherapy were at high risk for venous thrombosis (VT)and pulmonary embolism (PE).It was important to analyze a patient' s individual risk for VT and PE.Appropriate thrombosis prophylaxis ought to be considered highly for high risk patients.