妇科恶性肿瘤导致Trousseau综合征3例报道并文献复习

发布时间：2018-07-24 19:29

【摘要】：目的:通过病例回顾及文献复习提高对妇科恶性肿瘤合并肺栓塞的认识。方法:收集2011年至2014年山东大学齐鲁医院收治的3例妇科恶性肿瘤合并肺栓塞患者,回顾分析其临床表现、实验室及辅助检查、治疗策略、疾病预后及转归情况,并复习相关文献。结果:2例患者因腹胀、憋气首诊于消化内科,后因发现盆腔包块收住于妇科,术前查体发现肺栓塞;1例以下肢静脉血栓取栓后突发胸闷收入呼吸内科,诊疗过程中发现妇科恶性肿瘤。3例患者中,2例卵巢癌(IIIC期1例,IIB期1例),1例子宫内膜癌(III期)。2例患者在抗凝基础上给予新辅助化疗两个疗程后行手术治疗,1例抗凝治疗症状缓解后行手术治疗。术后均接受铂类+紫杉醇类的化疗6疗程。随访至今患者均存活,术后抗凝3个月后停止抗凝治疗后未再发生血栓。结论:妇科恶性肿瘤易合并栓塞性疾病,有时以血栓性疾病首发。有胸闷、憋气等症状时应排除肺栓塞。治疗肺栓塞后应积极手术治疗,以去除血栓形成的诱因,改善患者预后。
[Abstract]:Objective: to improve the understanding of gynecological malignant tumor with pulmonary embolism through case review and literature review. Methods: three cases of gynecologic malignant tumor complicated with pulmonary embolism were collected from 2011 to 2014 in Qilu Hospital of Shandong University. The clinical manifestations, laboratory and auxiliary examinations, treatment strategy, prognosis and prognosis of the disease were retrospectively analyzed. And review the relevant literature. Results two patients with abdominal distension, holding breath were first diagnosed in the Department of Digestive Medicine, then pelvic masses were found in gynecology. Before operation, pulmonary embolism was found in 1 patient with sudden chest tightness after thrombus removal of venous thrombosis of the lower extremity into the Department of Respiratory Medicine. In the course of diagnosis and treatment, 2 out of 3 patients with gynecological malignant tumor were diagnosed as ovarian cancer (1 case in IIIC stage II B) and 1 case in endometrial carcinoma (III stage). 2 cases were treated with neoadjuvant chemotherapy on the basis of anticoagulation and 1 case was treated with anti-tumor after two courses of neoadjuvant chemotherapy. Coagulant therapy was performed after remission of symptoms. All patients were treated with platinum paclitaxel for 6 courses of chemotherapy. All patients survived and no thrombus occurred after 3 months of anticoagulant therapy. Conclusion: gynecologic malignant tumors are easy to be associated with embolism and sometimes start with thrombotic diseases. Pulmonary embolism should be ruled out when there are chest tightness, suffocation and other symptoms. In order to remove the inducement of thrombosis and improve the prognosis of patients with pulmonary embolism, surgical treatment should be actively performed.
【作者单位】：山东大学齐鲁医院妇产科;日照市莒县人民医院;
【分类号】：R737.3

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