恶性肿瘤合并肺血栓栓塞症67例临床分析-内科学专业论文.docxVIP

恶性肿瘤合并肺血栓栓塞症 67 例临床研究摘要目的 探讨恶性肿瘤合并肺血栓栓塞症（Pulmonary Thromboembolism，PTE）的危 险因素、临床特征及诊治方法，以期提高临床医师对该病的认识及诊治水平。方法 对 2000 年 1 月-2009 年 12 月在宁夏医科大学附属医院住院的 67 例恶性肿瘤 合并 PTE 患者完整的临床资料进行回顾性研究。结果：10 年住院确诊的 602 例 PTE 患者中，恶性肿瘤合并 PTE 者 67 例，占 11.1%， 其中 66 例经 CTPA 确诊，占 98.5%。除年龄和恶性肿瘤外，最常见的危险因素为接受化 疗和近期手术（67.2%）。恶性肿瘤原发部位以呼吸系统（29.9%）和消化系统（34.3%） 最常见,常见恶性肿瘤依次为肺癌（29.9%），胃癌（13.4%），乳腺癌（9%）,直肠癌（6%） 卵巢癌（4.5%）肾癌（4.5%）等，恶性肿瘤类型以腺癌多见。呼吸困难/气短（79.1%） 是最常见的症状,其次为咳嗽(49.3%)和胸闷（37.3%）。胸腔积液（49.3%）、肺湿啰音（29.9%）、右下肢水肿（14.9%）是最常见的体征。60 例接受抗凝或溶栓治疗，治愈 14例（23.3%），好转 29 例（48.3%），无效 13 例（21.7%），死亡 4 例（6.7%）。结论:PTE 是恶性肿瘤的常见并发症和死亡原因之一，常同时合并 DVT，最常见于肺 癌和胃癌。危险因素中，除年龄和恶性肿瘤外，接受化疗或近期手术最常见。临床表现 无特异性，溶栓或抗凝是最基本的治疗方法。关键词：恶性肿瘤，肺血栓栓塞症，危险因素 外科手术Pulmonary Thromboembolism in Cancer: Clinical Research of 67 CasesABSTRACTObjective To explore the risk factors、clinical featuers and treatment of cancer with pulmonary thromboembolism (PTE),so as to attract more attention to the prevention, diagnosis and treatment of this disease.Methods A total of 67 inpatients diagnosed as cancer with PTE from January 2000 to December 2009 were retrospectively reviewed .Results In 602 inpatients diagnosed as PTE,67 of cases were diagnosed as cancer with PTE during 10-year,the ratio was 11.1%, and 66 cases were diagnosed by CTPA,the ratio was 98.5%.Besides aging and cancer, the most common risk factors were chemotherapy and undergoing operation recently(67.3%).The primary cancers were from respiratory system (29.9%)and digestive system(34.3%).Among the cases lung cancer was the most common(29.9%),followed by stomach(13.4%) 、breast(9%)、rectal(6%)、ovarin(4.5%) and kidney(4.5%)cancer.Dyspnea/short of breath(79.1%) were the most common presentation ，then cough(49.3%)and chest tightness(37.3%); Pleural effusion(43.9%) was the most common signs ,then ausculation(29.9%)and right lower extremity edema(14.9%).60 patients weretreated with anticoagulaton or thrombolytic therapy, 14 patients cured(23.3%) ，29 patientsimproved (48.3%),13 patients inv