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局部晚期宫颈癌放化疗及近距离放疗后发生的近乎致命性鞍状肺栓塞：病例系列

Near-fatal saddle pulmonary embolism following chemoradiotherapy and brachytherapy for locally advanced cervical cancer: A case series.

作者信息

Leijtens Lisa, Piek Jurgen, Kamps Marlijn, Oele-Egelmeer Ada, Daniëls-Gooszen Alette, Bekkers Ruud, Cnossen Jeltsje

机构信息

Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands.

GROW - Research Institute for Oncology and Reproduction, Maastricht University, the Netherlands.

出版信息

J Contemp Brachytherapy. 2025 Jun;17(3):197-201. doi: 10.5114/jcb.2025.152543. Epub 2025 Jun 30.

DOI:10.5114/jcb.2025.152543
PMID:40697723
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12277952/
Abstract

PURPOSE

Women with locally advanced cervical cancer treated with chemoradiotherapy followed by brachytherapy are at increased risk of venous thromboembolic events.

CASE PRESENTATION

This case series reported three women, who experienced near-fatal saddle pulmonary embolisms shortly after undergoing high-dose-rate brachytherapy for locally advanced cervical cancer. In one patient, pulmonary saddle embolism led to hypovolemic shock due to intra-abdominal hemorrhage post-resuscitation, necessitating emergency decompressive laparotomy. Another case was complicated by neurological symptoms consistent with a stuttering stroke, following mechanical pulmonary thrombectomy.

CONCLUSIONS

Pulmonary embolism represents a severe complication of chemoradiotherapy and brachytherapy. Given the high morbidity and mortality rates associated with this condition, routine thromboprophylaxis may be warranted.

摘要

目的

接受放化疗后再行近距离放疗的局部晚期宫颈癌女性发生静脉血栓栓塞事件的风险增加。

病例报告

该病例系列报道了三名女性，她们在接受局部晚期宫颈癌的高剂量率近距离放疗后不久发生了近乎致命的鞍状肺栓塞。在一名患者中，肺鞍状栓塞导致复苏后腹腔内出血引起的低血容量性休克，需要紧急减压剖腹手术。另一例在机械性肺血栓切除术后出现与口吃性中风一致的神经症状。

结论

肺栓塞是放化疗和近距离放疗的严重并发症。鉴于这种情况的高发病率和死亡率，可能有必要进行常规血栓预防。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/937b/12277952/7db3d8b92244/JCB-17-56382-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/937b/12277952/fb783bd0aa4b/JCB-17-56382-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/937b/12277952/d01c1d163291/JCB-17-56382-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/937b/12277952/7db3d8b92244/JCB-17-56382-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/937b/12277952/fb783bd0aa4b/JCB-17-56382-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/937b/12277952/d01c1d163291/JCB-17-56382-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/937b/12277952/7db3d8b92244/JCB-17-56382-g003.jpg

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本文引用的文献

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Gynecol Oncol. 2025 Feb;193:41-48. doi: 10.1016/j.ygyno.2024.12.015. Epub 2025 Jan 7.
2
Predicting VTE and utility of thromboprophylaxis in metastatic and recurrent cervical cancer.预测转移性和复发性宫颈癌的 VTE 风险和血栓预防的效用。
Gynecol Oncol. 2024 Sep;188:22-26. doi: 10.1016/j.ygyno.2024.05.028. Epub 2024 Jun 14.
3
Considerations for pharmacologic thromboprophylaxis following inpatient brachytherapy for gynecologic malignancies.
妇科恶性肿瘤住院后近距离放射治疗的药物性血栓预防考虑因素。
Brachytherapy. 2023 Sep-Oct;22(5):630-639. doi: 10.1016/j.brachy.2023.06.002. Epub 2023 Jun 30.
4
Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Guideline Update.静脉血栓栓塞症预防和治疗癌症患者：ASCO 指南更新。
J Clin Oncol. 2023 Jun 1;41(16):3063-3071. doi: 10.1200/JCO.23.00294. Epub 2023 Apr 19.
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Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline.癌症患者的静脉血栓栓塞：ESMO临床实践指南
Ann Oncol. 2023 May;34(5):452-467. doi: 10.1016/j.annonc.2022.12.014. Epub 2023 Jan 10.
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Risk factors for venous thromboembolism induced by prolonged bed rest during interstitial brachytherapy for gynecological cancer: a retrospective study.妇科恶性肿瘤近距离治疗后长期卧床致静脉血栓栓塞症的危险因素：一项回顾性研究。
Radiat Oncol. 2021 Jun 29;16(1):121. doi: 10.1186/s13014-021-01840-3.
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Association between Radiotherapy and Risk of Cancer Associated Venous Thromboembolism: A Sub-Analysis of the COMPASS-CAT Study.放疗与癌症相关静脉血栓栓塞风险之间的关联：COMPASS-CAT研究的亚组分析
Cancers (Basel). 2021 Mar 2;13(5):1033. doi: 10.3390/cancers13051033.
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Arterioscler Thromb Vasc Biol. 2021 Apr;41(4):1291-1305. doi: 10.1161/ATVBAHA.120.314378. Epub 2021 Feb 11.
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Radiation Therapy for Cervical Cancer: Executive Summary of an ASTRO Clinical Practice Guideline.宫颈癌放射治疗：ASTRO 临床实践指南摘要。
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