恶性肿瘤并发深静脉血栓的溶栓治疗  

Thrombolysis Therapy to Deep Venous Thrombosis Complicated by Malignancy

作　　者：周晓娟[1] 张洪[1] 许峰[1] 李平[1] 

机构地区：[1]四川大学华西医院肿瘤放疗科,四川成都610041

出　　处：《华西医学》2006年第2期266-267,共2页West China Medical Journal

摘　　要：目的：探讨恶性肿瘤伴发深静脉血栓形成（DVT）的发病机制和治疗对策。方法：分析45例在放化疗期间并发DVT的恶性肿瘤病人的临床特点、治疗方案、中心静脉置管使用等。其中41例患者接受了溶栓治疗，观察其疗效。结果：（1）19例（42．2％）患者接受过激素治疗，17例（37．8％）合并感染。（2）29例（64．4％）患者中进行了中心静脉置管，血栓形成时间在置管后平均7．4（3～12）周。（3）42例（93．3％）患者接受了化疗，使用频率较高的药物为DDP（66．7％）、NVB（40．5％）、5-Fu（19．0％）。（4）溶栓治疗总有效率65．8％，治疗前后血浆D-二聚体阳性率分别为85．4％和9.8％（P〈0．05），出现DVT症状到开始溶栓治疗的时间间隔〈24小时者溶栓治疗有效率为88．9％，24～72小时者为69．2％，〉72小时者为16．7％，1例患病者发生肺栓塞死亡。结论：（1）激素治疗、合并感染、化疗及长时间中心静脉置管可能是恶性肿瘤患者DVT形成的机制。（2）溶栓疗法对恶性肿瘤合并的DVT有一定疗效，及早治疗有助于提高疗效，肺栓塞是值得注意的副作用。Objective： To analyze the pathogenesy and treatment of malignancy complicated by deep venous thrombosis （DVT）. Methods： 45 cases of malignancy complicated by DVT during radiotherapy and chemotherapy were analyzed with the clinical feature, therapeutic regimen, use of central venous catheter, etc. 41 cases received thrombolysis therapy, and the therapeuticefficacy observed. Results： （1） 19 cases （42.2%） received corticosteroid therapy, 17 cases （37.8%） existed concurrent infection. （2） 29 cases （64.4%） accepted central venous catheter placement, the average time from the catheter been put to thrombogenesis was 7.4 （3 ～12） weeks. （3） 42 cases （93.3%） accepted chemotherapy, the drug in high use frequency were DDP （66.7 % ）, NVB （40. 5 % ）, 5 - Fu （ 19.0 % ）. （ 4 ） The total effective rate of thrombolysis therapy was 65.8 %, the express rate of plasma D - dimer before and after therapy was 85.4% and 9.8% respectively （ P 〈 0.05）. The effective rate of thrombolysis therapy was 88.9%, 69.2%, and 16.7% when the interval between the thrombolysis therapy and the initial symptom was 〈 24h, 24 ～72h, 〉 72h respectively. 1 case died of PE. Conclusions： （ 1 ） Corticosteroid therapy, concurrent infection, chemotherapy and long term central venous catheter are the probable pathogenesy of DVT to the patients with malignancy. （2） The thrombolysis therapy has a certain effect to the DVT complicated by malignancy, beginning the therapy as soon as possible may raise the curative effect, while PE is the side effect notable.

关 键 词：恶性肿瘤 血栓形成 溶栓治疗 

分 类 号：R730.5[医药卫生—肿瘤]