血栓形成与肿瘤技术方案.pptVIP

静脉血栓栓塞症 DVT（deep venous thrombosis）血液在深静脉内不正常凝结引起的病症 多发生在下肢 血栓脱落可引起肺栓塞（pulmonary embolism，PE） DVT 的诊断 In 2006, Scarvelis and Wells overviewed a set of clinical prediction rules for DVT on the heels of a widely adopted set of clinical criteria for pulmonary embolism. Wells score or criteria: (Possible score -2 to 9) Active cancer (treatment within last 6 months or palliative) +1 point Calf swelling 3?cm compared to other calf (measured 10?cm below tibial tuberosity) +1 point Collateral superficial veins (non-varicose) +1 point Pitting edema (confined to symptomatic leg) +1 point Previous documented DVT +1 point. Swelling of entire leg +1 point Localized pain along distribution of deep venous system +1 point Paralysis, paresis, or recent cast immobilization of lower extremities +1 point Recently bedridden 3 days, or major surgery requiring regional or general anesthetic in past 4 weeks +1 point Alternative diagnosis at least as likely -2 points Interpretation: Score of 2 or higher — deep vein thrombosis is likely. Consider imaging the leg veins. Score of less than 2 — deep vein thrombosis is unlikely. Consider blood test such as d-dimer test to further rule out deep vein thrombosis. PE的诊断 静脉血栓栓塞症临床表现 静脉血栓栓塞症与肿瘤 静脉血栓性栓塞症(venous thromboembolism) 肿瘤患者的VTE发生率较正常人增加了4到6倍 25%的病例与癌症有关： 急性VTE：20%已查出肿瘤 特发性VTE：10%患者12个月之内查出肿瘤 According to Virchows triad, venous thrombosis occurs via three mechanisms: decreased flow rate of the blood, damage to the blood vessel wall and an increased tendency of the blood to clot (hypercoagulability). Several medical conditions can lead to DVT, such as compression of the veins, physical trauma, cancer, infections, certain inflammatory diseases and specific conditions such as stroke, heart failure or nephrotic syndrome. There are several factors which can increase a persons risk for DVT, including surgery, hospitalization, immobilization (such as when orthopedic casts are used, or during long-haul flights, leading to trav