以静脉血栓形成为早期临床表现的消化道恶性肿瘤的临床特点研究  

Clinical Study of Gastrointestinal Malignancies with VTE as the Initial Manifestation

作　　者：韩洪超[1] 许洁[1] 王爱坤[1] 徐越超[2] HAN Hong-chao;XU Jie;WANG Ai-kun;XU Yue-chao(Department of General Surgery,Yancheng Third People's Hospital,Yancheng 224000,China;Department of Gastric and Colorectal Surgery,Bethune First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]盐城市第三人民医院普外科,江苏省盐城市224000 [2]吉林大学白求恩第一医院胃结直肠外科,吉林省长春市130021

出　　处：《中国全科医学》2018年第22期2716-2719,共4页Chinese General Practice

摘　　要：目的探讨以静脉血栓形成(VTE)为早期临床表现的消化道恶性肿瘤的临床特点,以期提高临床医师对此类恶性肿瘤的诊治意识,改善患者预后。方法选取2012年1月—2017年1月于盐城市第三人民医院收治的、被明确诊断为消化道恶性肿瘤并发VTE的患者42例。将患者分为两组,对照组:以消化道恶性肿瘤诊断入院,在医院接受手术之后或诊治期间首次出现VTE的患者;研究组:以VTE为首发症状就诊、进一步诊断出消化道恶性肿瘤、且未接受手术治疗的患者。通过查阅病历的方法,收集两组患者的临床资料,包括性别、年龄、体质指数(BMI)、有无合并症、VTE发生部位、肿瘤发生部位、肿瘤的组织学类型及侵犯程度、入院时首次相关实验室检查结果等。结果42例患者中,以VTE为首发症状的消化道恶性肿瘤患者17例(40.5%),对照组25例(59.5%)。研究组患者男性比例、VTE发生在双下肢的患者比例、肿瘤发生在胃部的患者比例高于对照组,差异有统计学意义(P<0.05);两组患者年龄、BMI、合并症、VTE发生部位(除外双下肢)、肿瘤组织学类型、肿瘤侵犯情况比较,差异无统计学意义(P>0.05)。研究组D-二聚体水平、血小板计数及纤维蛋白原水平高于对照组,而血红蛋白水平低于对照组,差异均有统计学意义(P<0.05)。结论以原发性VTE为早期临床表现的消化道恶性肿瘤,男性患者发病率相对较高,双侧DVT的发生率较高,且以胃恶性肿瘤为主。提醒临床医生在诊治过程中,若遇有不明原因的VTE患者,尤其是男性、双侧下肢VTE患者,应高度警惕其并发胃恶性肿瘤的可能性。Objective To explore the clinical features of gastrointestinal malignancies with venous thromboembolism(VTE)as the initial manifestation,so as to improve the diagnosis and treatment of these diseases to enhance the patients'prognosis.Methods The 42 participants with a definite diagnosis of gastrointestinal malignancies with VTE were enrolled from Yancheng Third People's Hospital from January 2012 to January 2017,including 25(59.5%)who had VTE after surgery or during the hospitalization(control group)and 17(40.5%)who sought medical care due to VTE,but were diagnosed with gastrointestinal malignancies after admission and did not receive surgical treatment(study group).Through reviewing the medical records,we collected their clinical data,including sex,age,BMI,prevalence of underlying diseases,site of VTE,site of cancer,histological type of cancer,degree of cancer invasion,admission laboratory results and so on.Results Compared with the control group,the proportion of males,the incidence of VTE in both lower limbs and the percent of gastric carcinoma were higher in the study group(P<0.05).Moreover,the average levels of D-dimer,platelet count and fibrinogen were higher,but the average level of hemoglobin was lower in the study group(P<0.05).However,both groups showed no significant differences in the distribution of age,BMI,site of VTE(except both lower limbs),tumor histological type and the degree of cancer invasion as well as the incidence of complications(P>0.05).Conclusion Gastrointestinal malignancy with VTE as the initial manifestation is more common in males,frequently manifested by DVT in both lower limbs,and gastric cancer is in the majority.Therefore,patients,especially males having VTE in both lower limbs due to unknown reasons,may be considered with gastric cancer possibly.

关 键 词：静脉血栓栓塞 消化系统肿瘤 早期表现 预防 

分 类 号：R543[医药卫生—心血管疾病] R735[医药卫生—内科学]