Clinical analysis of tumor related venous thromboembolism: 196 cases

申丽华; 张忠伟; 朱　彪

doi:10.3969/j.issn.1007-3969.2016.04.009

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Clinical analysis of tumor related venous thromboembolism: 196 cases

更新时间：2025-12-31

- Clinical analysis of tumor related venous thromboembolism: 196 cases
- China Oncology Vol. 26, Issue 4, Pages: 338-345(2016)
- 作者机构：
  
  复旦大学附属肿瘤医院麻醉科重症监护室，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2016.04.009
  CLC：
- Published Online：16 June 2016，
  
  Published：16 June 2016
- 稿件说明：
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申丽华,张忠伟,朱　彪. 肿瘤并发静脉血栓形成196例临床分析[J]. 中国癌症杂志, 2016, 26(4): 338-345.

申丽华, 张忠伟, 朱　彪. Clinical analysis of tumor related venous thromboembolism: 196 cases[J]. China Oncology, 2016, 26(4): 338-345.
申丽华,张忠伟,朱　彪. 肿瘤并发静脉血栓形成196例临床分析[J]. 中国癌症杂志, 2016, 26(4): 338-345. DOI： 10.3969/j.issn.1007-3969.2016.04.009.

申丽华, 张忠伟, 朱　彪. Clinical analysis of tumor related venous thromboembolism: 196 cases[J]. China Oncology, 2016, 26(4): 338-345. DOI： 10.3969/j.issn.1007-3969.2016.04.009.

摘要

背景与目的：静脉血栓形成(venous thromboembolism，VTE)是恶性肿瘤患者的第二常见死亡原因。通过了解复旦大学附属肿瘤医院5年间收治的患者VTE的发病情况，分析VTE的相关特点，以提高肿瘤合并VTE的诊断和防治意识，改善患者预后。方法：对复旦大学附属肿瘤医院2009年7月—2014年6月收治的196例肿瘤并发VTE的患者的临床资料进行回顾性分析。分析肿瘤并发VTE的临床特点及发病情况，了解相关因素对VTE发病的影响，了解VTE首发情况。结果：复旦大学附属肿瘤医院5年间共收治肿瘤患者207 514例，其中VTE患者196例，肿瘤并发VTE发生率为0.94‰。腺癌在妇科肿瘤(56.5%)、胃肠道肿瘤(91.7%)、肺癌(71.4%)和胰腺癌(80%)中所占比例较高。单变量Logistic回归分析显示，腺癌为肿瘤患者并发肺栓塞(pulmonary embolism，PE)的高危险因素(OR=0.36，95%CI：0.146~0.885，P=0.026)。化疗大于2次者明显比化疗小于等于2次者VTE的发生率更高(χ

=10.976，P=0.001)。手术组VTE发生率高于非手术组。妇科肿瘤中有大量腹水者的非手术患者并发VTE者(2 000 mL)更多(34.1% vs 10.7%，P=0.015)。术后和放化疗期间78%~88%的患者因出现深静脉血栓(deep vein thrombosis，DVT)症状发现VTE，而术前检查期间主要是在下肢静脉加压超声(compression venous ultrasonography，CUS)检查发现(59.1%)。复旦大学附属肿瘤医院术后进行物理性预防血栓措施者为15例(13.9%)。结论：复旦大学附属肿瘤医院的肿瘤相关性VTE发生率较其他流行病学调查发生率低。肿瘤患者术后并发VTE的风险明显高于非手术者。腺癌更易并发PE。对于临床无VTE症状的肿瘤患者和大量腹水的妇科肿瘤患者应积极进行VTE的相关检查，术后应更积极采取物理抗栓措施。

Abstract

Background and purpose: Venous thromboembolism (VTE) is the second common cause of death in cancer patients. The clinical data from VTE patients in Fudan University Shanghai Cancer Center were collected and analyzed during the last 5 years in this study to increase awareness for diagnosis and prevention of VTE in cancer patients and to improve their prognosis. Methods: The clin

ical data from 196 VTE patients among the 207 514 cancer patients were analyzed during the period from Jul. 2009 to Jun. 2014

and the clinical characteristics of cancer patients with VTE were investigated to understand the influence of risk factors and symptoms in VTE patients. Results: The incidence of VTE in cancer patients was 0.94‰. Adenocarcinoma was the most common type of gynecological cancer (56.5%)

gastrointestinal tract cancer (91.7%)

lung cancer (71.4) and pancreatic cancer (80%). Logistic regression analysis showed adenocarcinoma was the high risk factor in cancer patients with pulmonary embolism (PE

OR=0.36

95%CI: 0.146-0.885

P=0.026). Compared with patients who received 2 cycles of chemotherapy

patients who received 3 cycles of chemotherapy had higher incidence of VTE (χ

=10.976

P=0.001). The incidence of VTE in operative group was higher than that in non-operative group. The patients bearing gynecological cancer with ascites (2 000 mL) had higher VTE incidence compared with the patients with less ascites. Besides

78%-88% of the VTE patients were diagnosed because of the deep vein thrombosis (DVT) symptom during postoperative recovery and chemoradiotherapy. However

59.1% of the preoperative VTE patients were diagnosed by the compression venous ultrasonography (CUS) in lower extremity. Physical therapy was adopted to prevent thrombus in 15 postoperative patients. Conclusion: The incidence of cancer-associated VTE in Fudan University Shanghai Cancer Center is lower compared with those reported in other epidemiologic investigations. The VTE incidence in postoperative patients is higher than that in preoperative patients. The patients with adenocarcinoma were inclined to be accompanied by PE. The examination should be taken in asymptomatic cancer patients and gynecological cancer patients with massive ascites. The physical measurement should be adopted actively to prevent thrombus in our hospital.

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