Agnelli Giancarlo, Verso Melina
Internal Medicine, University of Perugia, Italy.
Nat Clin Pract Oncol. 2006 Apr;3(4):214-22. doi: 10.1038/ncponc0458.
Central venous catheters (CVCs) have improved the management of patients with cancer substantially, by facilitating chemotherapy and supportive therapy. The use of CVCs is associated with complications such as infection and upper-limb deep vein thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to the use of CVCs ranges between 2% and 4%. In the most recent study, the incidence of CVC-related thrombosis, as screened by venography, was approximately 18% in the absence of prophylaxis. In cancer patients with CVC-related UL-DVT, the incidence of clinically overt pulmonary embolism was between 15% and 25%, and the incidence of autopsy-proven pulmonary embolism was up to 50%. Pathogenic factors for CVC-related thrombosis include vessel injury caused by the CVC insertion procedure, venous stasis because of the indwelling CVC, and hypercoagulability associated with cancer. Recent studies have not confirmed a benefit for prophylaxis with antithrombotic agents for CVC-related thrombosis. The recommended treatment for CVC-related thrombosis is based on long-term anticoagulant therapy, with or without catheter removal.
中心静脉导管（CVCs）通过促进化疗和支持治疗，极大地改善了癌症患者的治疗管理。CVCs的使用与感染和上肢深静脉血栓形成（UL-DVT）等并发症相关。与使用CVCs相关的临床显性UL-DVT的发生率在2%至4%之间。在最近的研究中，在未进行预防的情况下，通过静脉造影筛查的CVC相关血栓形成的发生率约为18%。在患有CVC相关UL-DVT的癌症患者中，临床显性肺栓塞的发生率在15%至25%之间，经尸检证实的肺栓塞发生率高达50%。CVC相关血栓形成的致病因素包括CVC插入操作引起的血管损伤、因留置CVC导致的静脉淤滞以及与癌症相关的高凝状态。最近的研究尚未证实抗血栓药物预防CVC相关血栓形成的益处。CVC相关血栓形成的推荐治疗方法是基于长期抗凝治疗，可拔除或不拔除导管。
