Li Guo, Lu Wei-Xuan, Wang Chen
Department of Respiralogy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Zhonghua Zhong Liu Za Zhi. 2009 Jul;31(7):550-3.
To enhance the understanding of pulmonary thromboembolism (PTE) in patients with cancer.
from January 2005 to July 2008, sixty patients diagnosed as pulmonary thromboembolism in Peking Union Medical College Hospital were retrospectively reviewed.
The primary cancers were from respiratory system (36.7%), digestive system (26.7%), urogenital system (10.0%), hematological system (8.3%) and nervous system (5.0%), respectively, especially from such organ as lung (30.0%), stomach (8.3%), pancreas (6.7%), liver (5.0%) and so on. 12 of 18 patients (66.7%) with lung cancer were adenocarcinoma. There were 47 patients (78.3%) with advanced cancer. Deep venous thrombosis (DVT) occurred in 30 patients (50.0%). Of them 24 patients (80.0%) occurred in the lower limb, and 3 patients (10%) in the upper limb, 5 patients (16.7%) in other sites including 2 cases with thrombi in both upper and lower limbs, respectively. There were 2 patients (3.3%) accompanied with femoral artery embolism. PTE before tumor diagnosed occurred in 5 patients (8.3%) with an average time of 5.5 months. 22 patients underwent cancer-related operation and 17 patients (77.3%) had PTE in the later 2 weeks. 15 patients (25.0%) showed no symptoms. Arterial oxygen partial pressure was reduced in 49 patients (84.5%). 13 patients (21.7%) died and 6 cases of them were sudden death. 8 patients (13.3%) aggravated. 39 patients (65.0%) improved.
PTE is one of the major complications and leading causes of death in patients with cancer. Of which lung cancer is most commonly, pulmonary adenocarcinoma in particular. PTE is often accompanied by DVT in the lower extremity. Risk factors may be old age, cancer progression and cancer-related operation. Other factors include long time in bed, chemotherapy and central vein catheterization, and so on. It should be watchful of PTE in cancer patients undergoing operation, especially within the first two postoperative weeks. Its clinical manifestation is often atypical. Sometimes venous thromboembolism (VTE) is the first signal of malignancy. In patients with unexplained PTE and/or DVT, attention should be paid to the possibility of malignancy. The first choice of anticoagulants is low molecular weight heparin.
提高对癌症患者肺血栓栓塞症（PTE）的认识。
回顾性分析2005年1月至2008年7月在北京协和医院确诊为肺血栓栓塞症的60例患者。
原发癌分别来自呼吸系统（36.7%）、消化系统（26.7%）、泌尿生殖系统（10.0%）、血液系统（8.3%）和神经系统（5.0%），尤其来自肺（30.0%）、胃（8.3%）、胰腺（6.7%）、肝（5.0%）等器官。18例肺癌患者中有12例（66.7%）为腺癌。有47例（78.3%）为晚期癌症。30例患者（50.0%）发生深静脉血栓形成（DVT）。其中24例（80.0%）发生在下肢，3例（10%）发生在上肢，5例（16.7%）发生在其他部位，包括2例上下肢均有血栓形成。有2例患者（3.3%）伴有股动脉栓塞。肿瘤确诊前发生PTE的有5例患者（8.3%），平均时间为5.5个月。22例患者接受了与癌症相关的手术，17例患者（77.3%）在术后2周内发生PTE。15例患者（25.0%）无症状。49例患者（84.5%）动脉血氧分压降低。13例患者（21.7%）死亡，其中6例为猝死。8例患者（13.3%）病情加重。39例患者（65.0%）病情好转。
PTE是癌症患者的主要并发症之一和主要死亡原因。其中肺癌最常见，尤其是肺腺癌。PTE常伴有下肢DVT。危险因素可能是高龄、癌症进展和与癌症相关的手术。其他因素包括长期卧床、化疗和中心静脉置管等。对接受手术的癌症患者应警惕PTE，尤其是术后前两周内。其临床表现常不典型。有时静脉血栓栓塞症（VTE）是恶性肿瘤的首发信号。对于不明原因的PTE和/或DVT患者，应注意恶性肿瘤的可能性。抗凝剂的首选是低分子量肝素。
