利伐沙班桥接策略在抗血栓治疗的肺结节患者行经皮穿刺活检联合微波消融治疗中的应用  

Application of rivaroxaban bridging strategy in the treatment of percutaneous biopsy combined with microwave ablation in patients with lung nodules who are receiving antithrombotic therapy

作　　者：王楠 薛天宇 徐静雯 叶欣 WANG Nan;XUE Tianyu;XU Jingwen;YE Xin(Department of Oncology,Shandong Province Qianfoshan Hospital,Shandong Province Traditional Chinese Medicine University,Shandong Jinan 250014,China)

机构地区：[1]山东中医药大学第一临床医学院,山东省千佛山医院肿瘤中心,山东济南250014

出　　处：《现代肿瘤医学》2024年第20期3879-3885,共7页Journal of Modern Oncology

基　　金：中国博士后科学基金(编号:2022M711979);山东省济南市临床医学科技创新计划项目(编号:202225074);山东省千佛山医院国家自然培育基金(编号:QYPY2021NSFC0608)。

摘　　要：目的:评估利伐沙班作为桥接药物应用于正在进行抗血栓治疗的肺磨玻璃结节患者行经皮穿刺活检联合微波消融治疗的安全性及有效性。方法:本研究共纳入138例长期抗血栓治疗的肺磨玻璃结节患者,在2020年01月01日至2021年12月31日期间共进行了138次CT引导下同步经皮穿刺活检联合微波消融治疗。患者分为两组:A组患者术前5天桥接利伐沙班(10 mg/天),术前1天停止并在术后3天经评估后尽早恢复原剂量抗血栓药物;B组患者术前5天直接停止所有抗血栓药物,术后3天评估后尽早恢复。收集并分析两组患者的技术成功率、活检阳性率、局部控制率、出血和血栓并发症等,以明确利伐沙班作为桥接药物在这些患者治疗中的临床价值。采用欧洲心血管和介入放射学会并发症分类标准记录并发症级别,≥3级定为主要并发症。结果:A组患者58例[男:39例,女:19例;平均年龄±标准差:(71.12±6.46)岁],B组患者80例[男:55例,女:25例;平均年龄±标准差:(70.72±7.33)岁]。两组的技术成功率均为100%。A组和B组活检阳性率分别为94.83%(55/58)和96.25%(77/80)(P=0.4236)。A组和B组1个月、6个月、12个月和24个月的局部控制率分别为100.0%vs 98.75%、96.55%vs 98.75%、96.55%vs 93.75%和89.66%vs 91.25%。两组在围手术期及随访期的主要出血性并发症无统计学差异;术后3天至术后1个月随访时间内,B组的主要血栓性并发症发生率11.25%(9/80)显著高于A组1.72%(1/58)(P=0.0331)。结论:对于长期抗血栓治疗的肺磨玻璃结节患者行同步经皮穿刺活检联合微波消融治疗时,与围手术期直接停止抗凝药物的策略相比,使用利伐沙班作为桥接药物是安全且有效的,并可减少围手术期的主要血栓性并发症的发生。Objective:To evaluate the safety and efficacy of rivaroxaban as a bridge drug in the treatment of synchronous percutaneous biopsy and microwave ablation(B+MWA)for highly suspicious malignant lung ground-glass opacities(GGOs)in patients on antithrombotic therapy.Methods:The study comprised 138 patients with pulmonary GGOs receiving antithrombotic therapy.All patients underwent 138 synchronous CT-guided percutaneous B+MWA from January 1,2020 to December 31,2021.The patients were divided into two groups:Patients in Group A,received rivaroxaban(10 mg/d)5 days before procedure,stopped 1 day before procedure,and resumed the original dose as soon as possible 3 days after procedure.Patients in Group B,directly stopped all antithrombotic drugs 5 days before procedure and resumed as soon as possible 3 days after procedure.The technical success rate,biopsy positive rate,local control rate(LCR),hemorrhagic and thrombosis complications in the two groups were collected and analyzed.Complications were graded according to the Cardiovascular and Interventional Radiological Society of Europe(CIRSE)standard,major complications were defined as grade of complications more than 3 level.Results:Group A comprised 58 patients[male:39,female:19,mean age±SD:(71.12±6.46)years],and Group B comprised 80 patients[male:55,female:25,mean age±SD:(70.72±7.33)years].The technical success rate was 100%in both groups.The positive biopsy rates in Group A and Group B were 94.83%(55/58)and 96.25%(77/80),respectively(P=0.4236).The LCR of Group A and Group B at 1,6,12,and 24 months were 100.0%vs 98.75%,96.55%vs 98.75%,96.55%vs 93.75%and 89.66%vs 91.25%,respectively.During the periprocedural and follow-up period,there was no significant difference in major hemorrhagic complications between the two groups.However,the incidence of major thrombotic complications in Group B(11.25%,9/80)was significantly higher than that in Group A(1.72%,1/58)during the follow-up period from 3 days postoperatively to 1 month postoperatively(P=0.0331).Conclusion:Compared wit

关 键 词：肺磨玻璃结节 抗血栓治疗 微波消融 活检 安全性 有效性 

分 类 号：R734.2[医药卫生—肿瘤]