乳腺癌患者外周中心静脉导管相关上肢深静脉血栓形成的抗凝治疗  

Anticoagulant therapy for peripherally inserted central venous catheter related deep vein thrombosis of upper limb in patients with breast cancer

作　　者：李伟[1] 陈占[2] 鲁磊[1] 王冰涛[1] 尚宏清[1] Li Wei;Chen Zhan;Lu Lei;Wang Bingtao;Shang Hongqing(Department of Breast and Thyroid Surgery,Beijing Haidian Hospital,Beijing 100080,China;Department of Vascular Surgery,Beijing Haidian Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院乳腺甲状腺外科,北京100080 [2]北京市海淀医院血管外科,北京100080

出　　处：《血管与腔内血管外科杂志》2024年第3期327-331,共5页Journal of Vascular and Endovascular Surgery

基　　金：北京市海淀医院科研项目(KYM2022003)。

摘　　要：目的总结分析乳腺癌患者发生外周中心静脉导管(PICC)相关上肢深静脉血栓(DVT)形成的诊治经验。方法收集2021年6月至2023年3月北京市海淀医院收治的发生PICC相关上肢DVT的134例乳腺癌患者的临床资料,根据抗凝治疗方案的不同将患者分为低分子肝素组(n=65)和利伐沙班组(n=69)。比较两组患者的乳腺癌专科信息和启动抗凝治疗后3个月的随访结果。结果两组患者的临床分期、肿瘤部位、手术情况、放疗情况比较,差异均无统计学意义(P﹥0.05)。治疗后3个月随访结果显示,两组患者的导管功能失用率、上肢DVT复发率、出血发生率比较,差异均无统计学意义(P﹥0.05)。两组患者均发生了轻微出血。治疗前,两组患者的D-二聚体水平比较,差异无统计学意义(P﹥0.05);治疗后4、12周,两组患者的D-二聚体水平均较本组治疗前下降,差异均有统计学意义(P﹤0.05),但两组患者的D-二聚体水平比较,差异均无统计学意义(P﹥0.05)。结论低分子肝素与利伐沙班治疗乳腺癌患者PICC相关上肢DVT的疗效与安全性相当,但利伐沙班可能更方便患者出院后使用。Objective To summarize and analyze the experience of diagnosis and treatment of upper limb deep vein thrombosis(DVT)associated with peripherally inserted central venous catheter(PICC)in patients with breast cancer.Method The clinical data of 134 cases breast cancer patients with PICC related upper limb DVT admitted to Beijing Haidian Hospital from June 2021 to March 2023 were collected.According to the anticoagulant treatment regimen used after diagnosis of upper limb DVT,they were divided into low molecular weight heparin group(n=65)and rivaroxaban group(n=69).The special information of breast cancer and the follow-up results of 3 months after starting anticoagulation treatment were compared between the two groups.Result The comparison of clinical stage,tumor location,surgical condition,and radiotherapy between the two groups of patients showed no statistically significant differences(P>0.05).The 3-month follow-up results after treatment showed that the comparison of catheter dysfunction rate,the recurrence rate of upper limb DVT and incidence of bleeding between the two groups of patients showed no statistically significant differences(P>0.05).Both groups of patients experienced mild bleeding.Before treatment,there was no statistically significant difference in D-dimer levels between the two groups of patients(P>0.05);at 4 and 12 weeks after treatment,the D-dimer levels in both groups of patients decreased compared to before treatment,and the differences were statistically significant(P<0.05),however,there was no statistically significant difference in the D-dimer levels between the two groups of patients(P>0.05).Conclusion The efficacy and safety of low-molecular-weight heparin and rivaroxaban in the treatment of PICC related upper limb DVT in breast cancer patients are similar,but rivaroxaban may be more convenient for patients to use.

关 键 词：乳腺癌 外周中心静脉导管 深静脉血栓 低分子肝素 利伐沙班 

分 类 号：R543[医药卫生—心血管疾病]