乳腺癌化疗患者输液港导管周围附壁血栓形成的探讨  

Investigation of catheter-related thrombosis around the port in patients with breast cancer after chemotherapy

作　　者：陈莉[1] 罗凤[1] 邢雷[1] 厉红元[1] 刘洪[1] 

机构地区：[1]重庆医科大学附属第一医院内分泌乳腺外科,重庆400016

出　　处：《上海交通大学学报（医学版）》2017年第4期514-517,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：重庆市科学技术委员会基金(cstc2016shmszx0323)~~

摘　　要：目的·探讨乳腺癌患者使用完全植入式静脉输液港(TIVAP)化疗后导管相关附壁血栓形成的发生、危险因素及其治疗情况。方法·190例留置TIVAP化疗的乳腺癌患者,每疗程化疗前及取输液港前行颈部血管彩色超声检查,观察导管相关血栓形成的发生率、发生时间、危险因素及治疗结果。结果·190例患者中,112例(58.9%)发生导管相关附壁血栓形成;其中无症状血栓形成108例(占56.8%),症状性血栓形成4例(占2.1%)。置管后21 d时,输液港导管相关附壁血栓形成的发生率(22.1%)最高。年龄>60岁的患者、乳腺癌临床分期为III^IV级者以及TEC(多西紫杉醇联合表阿霉素和环磷酰胺同期化疗)化疗方案是输液港导管相关血栓形成的危险因素。经皮下注射低分子肝素、口服蚓激酶肠溶胶囊或继续口服阿司匹林的患者,血栓消失率的差异无统计学意义(P=0.743)。结论·乳腺癌化疗患者使用输液港导管相关症状性血栓发生率较低,但无症状性血栓形成的发生率较高,应给予重视。年龄、肿瘤分期和TEC化疗方案是输液港导管周围附壁血栓形成的危险因素。Objective· To investigate the incidence, risk factors and treatment of the catheter-related thrombosis （CRT） in breast cancer patients after implantation of totally implantable venous access port （TIVAP） in chemotherapy. Methods · A total of 190 cases after implantation of TIVAP were investigated. Color Doppler ultrasound was used to monitor the neck blood vessels to find whether there was CRT before chemotherapy and before taking out the port. The incidence of CRT, occurrence time, risk factors and treatment efficacy were observed. Results · There were 112 （58.9%） cases with CRT and 108 （56.8%） patients with asymptomatic thrombosis, and only 4 cases had symptomatic thrombosis, the incidence of which was 2.1%. Most thrombosis developed on the 21th day after catheterization, and the patients over the age of 60, with clinical stage Ⅲ - Ⅳ and chemotherapy regimens TEC （docetaxel combined pirubicin and cyclophosphamide） were the risk factors for thrombosis. All the patients with asymptomatic thrombosis accepted anticoagulant treatment with low molecular heparin, earthworms enzyme or aspirin, respectively, but there was no significant difference in efficacy in the three groups （P=0.743）. Conclusion · Port catheter related symptomatic thrombosis incidence is low but the incidence of symptomatic thrombosis is high in the breast cancer patients after chemotherapy. Age, tumor stage and TEC chemotherapy regimens are the risk factors for catheter-related thrombosis.

关 键 词：乳腺癌:完全植入式静脉输液港 血栓形成 发生率 

分 类 号：R737.9[医药卫生—肿瘤]