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恶性肿瘤与静脉血栓栓塞(venous thromboembolism,VTE)关系密切。恶性肿瘤患者发生VTE,不仅增加治疗难度,而且降低患者生存质量及减少生存预期,因此越来越受到临床医生重视,成为近期肿瘤研究的热点问题之一。肿瘤细胞可以直接分泌癌促凝物质,或通过激活单核细胞和巨噬细胞释放细胞因子。这些蛋白质因子诱导凝血反应,增加发生VTE的风险。某些特定类型的肿瘤,如原发性脑肿瘤、胰腺癌、卵巢癌、乳腺癌、结直肠癌及非小细胞肺癌发生VTE的风险较高。此外,多种原因所致静脉血液淤滞、抗肿瘤药物及孕激素类药物治疗也是VTE发生的危险因素。通过详细的病史询问、体格检查及相关实验室检查可以诊断大部分自发性VTE患者的隐匿性恶性肿瘤。进一步的检查手段能否增加患者生存受益,有待于进一步的临床试验研究。肿瘤患者外科术前予普通肝素、低分子量肝素(low molecular weight heparin,LMWH)及戊聚糖预防治疗可以有效降低发生VTE的风险,且三类药物具有相似效果。此类患者术后继续行LMWH抗凝治疗亦可以减少VTE的发病率。低剂量抗凝治疗并未降低行中心静脉插管的肿瘤患者发生导管相关血栓形成(catheter-related thrombosis,CRT)的风险。对肿瘤内科患者行抗凝预防治疗的必要性及有效性尚未明确。要制定预防血栓形成的最佳策略,仍有待于临床继续深入研究。
Malignant tumors and venous thromboembolism (VTE) are closely related. The occurrence of VTE in patients with malignant tumors not only increases the difficulty of treatment, but also reduces the quality of life of patients and reduces the expectation of survival. Therefore, it is paid more and more attention by clinicians and has become one of the hot issues in recent cancer research. Tumor cells either directly secrete cancerous procoagulant substances or release cytokines by activating monocytes and macrophages. These protein factors induce a clotting reaction, increasing the risk of developing VTE. Certain types of tumors, such as primary brain tumors, pancreatic cancer, ovarian cancer, breast cancer, colorectal cancer and non-small cell lung cancer, have a higher risk of developing VTE. In addition, venous blood stasis caused by a variety of reasons, anti-cancer drugs and progestin-like drugs are also risk factors for VTE. Through detailed history inquiry, physical examination and related laboratory tests can diagnose occult malignancies in most spontaneous VTE patients. Further examination can increase the survival benefit of patients, pending further clinical trials. Preoperative surgical treatment of unfractionated heparin, low molecular weight heparin (LMWH) and pentosan in cancer patients can effectively reduce the risk of developing VTE, and the three drugs have similar effects. Such patients continue to LMWH anticoagulation therapy can also reduce the incidence of VTE. Low-dose anticoagulation did not reduce the risk of catheter-related thrombosis (CRT) in patients with central venous catheter cancer. The necessity and effectiveness of anticoagulant prophylaxis in oncology patients are not yet clear. To develop the best strategy to prevent thrombosis, remains to be further studied in clinical.