Lim Wang Yng, Bozas Georgios, Noble Simon, Hart Simon, Maraveyas Anthony
Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK.
J Thromb Thrombolysis. 2015 Jul;40(1):37-41. doi: 10.1007/s11239-014-1143-9.
The clinical significance of isolated subsegmental pulmonary embolism (SSPE) remains an area of controversy. In cancer patients, venous thromboembolism (VTE) is common and is a major cause of morbidity and mortality. The management of overt VTE in cancer patients is well established, nevertheless the management of incidentally diagnosed PE and especially SSPE, an increasingly frequent finding with the ubiquity of thin-slice computed tomography is less well defined. We have surveyed current attitudes towards treating SSPE in cancer patients among oncologists, respiratory and palliative care physicians. The survey was conducted between September 2012 and May 2013. Physicians surveyed were asked to select their management plan from options available depending on the site, number, symptoms, and in the presence of previous VTE. 154 physicians responded. We observed differences in the attitudes towards treatment between different specialties. In the adjuvant setting, oncologists were more likely to immediately anticoagulate for a single SSPE than palliative care physicians or chest physicians (84 vs 46 vs 56 %, respectively, p = 0.001). In the metastatic setting the differences were smaller (89 vs 69 vs 76 %, respectively, p = 0.057) but palliative care physicians remained less likely to immediately anticoagulate even in the case of multiple-site SSPE (85 vs 96 %, p = 0.014). Despite the unknown clinical significance of SSPE, and the likelihood that even in cancer patients some of these SSPEs may have trivial effects on prognosis if left untreated, the majority of the physicians surveyed would opt for anticoagulation in patients with unsuspected SSPE regardless of its extent.
孤立性亚段肺栓塞（SSPE）的临床意义仍是一个存在争议的领域。在癌症患者中，静脉血栓栓塞（VTE）很常见，是发病和死亡的主要原因。癌症患者显性VTE的管理已很成熟，然而，偶然诊断出的肺栓塞尤其是SSPE的管理，随着薄层计算机断层扫描的普及这一发现越来越频繁，其定义却不太明确。我们调查了肿瘤学家、呼吸科和姑息治疗医生对癌症患者中SSPE治疗的当前态度。该调查于2012年9月至2013年5月进行。接受调查的医生被要求根据部位、数量、症状以及既往VTE的情况，从可用选项中选择他们的管理计划。154名医生做出了回应。我们观察到不同专业对治疗的态度存在差异。在辅助治疗环境中，肿瘤学家比姑息治疗医生或胸科医生更有可能对单个SSPE立即进行抗凝治疗（分别为84%、46%和56%，p = 0.001）。在转移性环境中差异较小（分别为89%、69%和76%，p = 0.057），但即使在多部位SSPE的情况下，姑息治疗医生立即进行抗凝治疗的可能性仍然较小（85%对96%，p = 0.014）。尽管SSPE的临床意义尚不清楚，而且即使在癌症患者中，一些未治疗的SSPE可能对预后影响很小，但大多数接受调查的医生会选择对未怀疑有SSPE的患者进行抗凝治疗，无论其范围如何。
