妇科肿瘤术后并发深静脉血栓29例分析

目的探讨妇科肿瘤术后并发深静脉血栓(deep venous thrombosis,DVT)的诊治及预防.方法回顾性分析29例妇科肿瘤术后并发DVT患者的临床资料.结果本组恶性肿瘤25例,占86.2%,平均年龄56.8岁,平均体重指数27.9.经血浆D-二聚体检测并结合静脉彩超检查,确诊后采用全身或者局部抗凝、溶栓等药物治疗或手术取栓治疗;并发肺动脉栓塞(pulmonary thromboembolism,PE)患者放置临时性下腔静脉滤器(inferior vena cava filter,IVCF)预防致死性PE,效果满意.结论恶性肿瘤、老年人、肥胖是妇科肿瘤术后DVT的高危因素,血浆D-二聚体检测结合静脉彩超可协助确诊,围手术期应积极预防DVT的发生,合理应用药物、介入和手术治疗可有效防治DVT.     

妇科肿瘤术后并发下肢深静脉血栓24例分析

目的：探讨妇科肿瘤患者术后并发下肢深静脉血栓形成（DVT）的原因、诊断治疗要点及预防措施。方法：回顾性分析24例妇科术后DVT的临床特点及诊断、治疗的方法。结果：发生DVT的高危因素是盆腔恶性肿瘤、老年妇女、血粘度增高、合并高血压、糖尿病及术后常规应用止血药等。治疗采用肝素、小剂量尿激酶、低分子右旋糖酐及复方丹参等，取得满意效果。结论：对有DVT高危因素的妇科肿瘤患者，手术前后应加强预防措施。     

妇科手术后下肢深静脉血栓形成21例临床分析

目的探讨妇科手术后下肢深静脉血栓形成（LEDVT）的防治措施。方法收集21例妇科手术后发生LEDVT患者的临床资料，并进行分析。结果妇科恶性肿瘤手术和阴式手术是发生下肢深静脉血栓的高危因素。2例手术取栓，19例经抗凝、溶栓治疗，患者治疗后均好转出院。结论LEDVT是妇科术后的常见并发症，应引起充分重视，对于高危患者并加强预防性治疗；抗凝、溶栓综合治疗是LEDVT的有效治疗手段。     

妇科恶性肿瘤导致Trousseau综合征3例报道并文献复习

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。     

妊娠期及产褥期下肢深静脉血栓形成10例临床资料分析

目的:探讨妊娠期及产褥期下肢深静脉血栓(DVT)形成的部位、类型、危险因素及治疗效果。方法:回顾分析2015年1月至2016年12月华中科技大学同济医学院附属同济医院妇产科收治的10例妊娠期及产褥期下肢DVT形成患者的临床资料。结果:下肢DVT患者10例,发生率为1.02/1000,妊娠期3例下肢DVT,形成部位位于髂外静脉及股静脉1例,右侧小腿肌间静脉1例,下肢深静脉1例;产褥期7例下肢DVT,形成部位位于小腿肌间静脉6例,胫后静脉1例。下肢DVT多见位于左侧,且肌间静脉血栓为最常见类型(7/10),其中6例为孤立性小腿肌间静脉血栓,1例为左侧腘窝浅静脉合并同侧多支小腿肌间静脉血栓形成。妊娠期及产褥期下肢DVT形成的常见危险因素包括剖宫产(9/10)、高龄(5/10)、BMI高(4/10)、长期卧床(4/10)、辅助生殖技术(3/10)。产褥期发现DVT时D-二聚体值较入院时明显升高(P0.05)。患者发现DVT后均立即给予低分子肝素抗凝治疗并嘱穿弹力袜动态观察,监测凝血功能无明显异常。治疗至产后1～3月,患者症状缓解,复查下肢静脉彩超,静脉血栓消失。结论:妊娠期及产褥期具有下肢DVT形成的高危因素,尤其下肢肌间静脉血栓发生率高,应早期识别下肢DVT的症状明确诊断,尽早给予低分子肝素抗凝治疗,安全有效,预后良好。     

剖宫产术后深静脉血栓形成的临床研究

目的:探讨剖宫产术后DVT的诊治及预防。方法:回顾分析2002年8月至2005年12月我科收治的剖宫产术后并发下肢DVT的患者47例,分析其临床特点及诊断治疗的方法,并结合文献复习讨论预防措施。结果:既往有血栓病史、经产妇、肥胖是剖宫产术后DVT的危险因素,主要临床症状为患肢粗肿、疼痛,部分患者有呼吸系统的非特异性症状,DVT的辅助诊断首选血浆D-二聚体检测结合静脉彩色多普勒超声显像。采用全身或局部抗凝、溶栓等药物或手术取栓治疗,部分患者放置可回收性IVCF预防致死性PE,均取得较好的近期疗效。结论:对于存在DVT危险因素的孕产妇,剖宫产手术前后应采取积极预防措施。LMWH是常用的和安全的抗凝药物,能有效预防和治疗DVT。     

子宫内膜癌围手术期症状性静脉血栓栓塞症23例临床特征分析

目的探讨子宫内膜癌患者围手术期症状性静脉血栓栓塞症(VTE)的临床特征、诊治及预防。方法回顾性分析2004年1月至2012年12月北京大学人民医院妇科住院的23例子宫内膜癌围手术期发生的症状性VTE患者的临床资料。结果 23例患者的平均年龄(58.1±8.3)岁,其中1例(4.3%)肺栓塞(PE)合并深静脉血栓(DVT),22例(95.7%)下肢深静脉血栓,均出现患肢肿胀或疼痛;21例(91.3%)DVT均发生在术后,其中19例(90.5%)发生于术后20天内。DVT均累及下肢静脉,其中单独累及肌间静脉14例(65.2%)。1例PE以放置下腔静脉滤器治疗;12例(54.5%)以低分子肝素皮下注射继以华法林口服治疗。术后平均随访(37.7±23.4)个月,5例(21.7%)患者死亡,其中4例死于肿瘤,1例死于脑梗,无VTE所致的死亡。结论子宫内膜癌围手术期症状性VTE主要发生在术后20天内,应积极预防。对术后出现肢体肿胀或者疼痛的患者应警惕血栓发生。     

妇科盆腔手术后下肢深静脉血栓11例分析

目的:探讨妇科盆腔手术后并发下肢深静脉血栓(LEDVT)的临床情况.方法:回顾分析本院1996年1月至2007年12月妇科盆腔手术后11例LEDVT的临床特点及诊断、治疗的方法.结果:LEDVT发生占妇科盆腔手术的0.2%.11例LEDVT的主要临床表现:低热,患侧下肢疼痛、肿胀、增粗,腓肠肌握痛,患肢活动困难,皮肤苍白或花斑样紫绀,皮温低.11例全部经彩色多普勒超声(彩超)而确诊.用低分子肝素钙、血栓通、低分子右旋糖酐治疗,或加用路路通、阿司匹林、活血化瘀中药治疗,10例经1个疗程治愈,1例经2个疗程治愈.结论:重视妇科盆腔手术后LEDVT的主要临床表现,结合彩超检查可确诊,及时溶栓、抗凝等治疗,效果满意.     

妊娠合并急腹症69例的临床特点与妊娠结局

目的:探讨妊娠合并急腹症的临床特点及妊娠结局。方法:回顾分析2007年1月至2014年5月我院收治的69例妊娠合并急腹症患者的临床资料。结果:39例妊娠合并阑尾炎均行手术治疗,术后流产1例,早产2例,切口感染3例。9例合并急性胰腺炎,2例手术治疗,术后1例自行选择流产,1例自然流产;7例保守治疗成功。7例合并急性胆囊炎,保守治疗3例,4例行手术治疗,术后流产1例。5例合并肠梗阻,3例保守治疗,2例保守无效行手术治疗;4例合并泌尿系统结石,2例保守治疗,2例手术治疗。5例合并卵巢囊肿蒂扭转均行手术治疗,术后早产1例。所有病例中无孕产妇死亡,均痊愈出院,所有新生儿包括早产儿均存活。结论:早期诊断和积极有效干预有利于改善妊娠结局、提高临床疗效,确保母儿安全。     

间歇性气囊加压与低分子肝素预防妇科良性病变手术治疗后下肢深静脉血栓形成的对比研究

目的:比较间歇性气囊加压和低分子肝素对预防妇科良性病变手术治疗后下肢深静脉血栓的预防效果。方法:将157例患者随机分为间歇性气囊加压(IPC)预防组(79例)与低分子肝素(LMWH)预防组(78例),术后1周内采用加压超声检查诊断深静脉血栓(DVT),比较患者手术前后的血常规、凝血检查等数据,并记录术中、术后并发症。结果:共发生4例DVT(2.5%),1例PE(0.6%)。IPC组2例DVT;LMWH组2例DVT,其中1例合并PE。4例DVT患者年龄均在60岁以上。两组患者的术后血红蛋白(Hb)、血小板(PLT),凝血酶时间(TT)均较术前显著减少(均为P0.001),D二聚体(Ddimer)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)和纤维蛋白原(Fbg)均显著增加(P0.01)。IPC组和LMWH组的抗凝血酶III(Anti-thrombin III,AT-III)手术前后变化无显著差异(P=0.686,P=0.061)。IPC与LMWH两组间手术前后Hb、PLT、D-dimer、PT、APTT、Fbg、TT、AT-III无显著差异。IPC组发生术后出血1例(1.7%),LMWH组发生术后出血7例(9.0%)。结论:对于因良性疾病行妇科手术的患者,应采取措施预防DVT,尤其是60岁以上的患者。IPC或LMWH均可有效减少术后DVT发生率,且IPC可取得与LMWH一致的血栓预防效果,并有较低的术后出血率。     

妇科肿瘤术后并发深静脉血栓的诊治与预防

目的 探讨妇科肿瘤术后并发下肢深静脉血栓（ＤＶＴ）的诊断治疗要点及预防措施。方法回顾性分析１１例妇科ＤＶＴ患者和１８例有ＤＶＴ倾向患者的临床特点及诊断、治疗和预防的方法。结果 发生ＤＶＴ的高危因素为中老年妇女、肥胖、原发病多为贫腔恶性肿瘤,特别是子宫内膜癌。辅助诊断方法以彩色多普勒血流显像为最佳。治疗采用肝素或低分子肝素事速避凝抗凝治疗,均取得较好效果。结论 中老年、肥胖的肿瘤患者,特别是恶性肿瘤     

Successful catheter-directed venous thrombolysis in phlegmasia cerulea dolens

BACKGROUND: Phlegmasia cerulea dolens is an extremely rare condition caused by complete venous occlusion and often results in tissue necrosis, limb amputation, or death. Treatment options include systemic anticoagulation, systemic thrombolytic therapy, fasciotomy, or surgical thrombectomy. Rare case reports have described the use of catheter-directed thrombolysis in the treatment of this condition. Prompt diagnosis and treatment initiation are important to prevent gangrene, amputation, and ultimately death. CASE: We report two unusual cases of phlegmasia cerulea dolens that presented in patients with aggressive gynecologic malignancies and who were successfully treated with catheter-directed thrombolytic therapy. CONCLUSION: To maximize the opportunity for limb salvage, catheter-directed venous thrombolytic therapy should be considered in the treatment of phlegmasia cerulea dolens that presents in the gynecologic oncology patient.     

腹腔镜下淋巴结清扫术后并发淋巴漏的临床分析

目的:探讨妇科恶性肿瘤患者行腹腔镜下淋巴结清扫术后淋巴漏的发生、危险因素、临床表现及诊断治疗方法。方法:回顾分析2009年9月至2012年8月在复旦大学附属妇产科医院行腹腔镜下腹膜后淋巴结清扫术的849例妇科恶性肿瘤患者的临床资料,分析患者术后淋巴漏发生的相关因素。结果:46例(5.42%)患者术后发生淋巴漏,其中42例为淡黄色引流液,4例为乳糜样引流液,引流量为300～1150ml/d。Logistic多元回归分析显示,淋巴结清扫数、淋巴结转移、术中出血量与淋巴漏发生有关。46例患者经限制饮食或禁食、静脉营养及引流等保守治疗后,均治愈。结论:淋巴漏的临床症状依据发生位置不同而表现各异。淋巴结转移、淋巴结清扫数及术中出血量是淋巴漏发生的危险因素。保守治疗及充分引流可获得满意效果;术中轻柔操作、提高手术技巧及术后预防性禁食可预防淋巴漏发生。     

Zukunft der Gynäkoonkologie

The gynecologist as gynecologic oncologist: Comprehensive knowledge about oncologic diseases of the breast and the female genital tract is an essential part of the residency program in Obstetrics and Gynecology. Medical training includes prevention, diagnostics, surgical, medical as well as complementary therapy and follow-up of female cancer. The fellowship in Gynecologic Oncology aims to deepen these basic skills. Knowledge in diagnosis and indications, respectively, for medical and surgical oncologic treatment strategies is expanded. Surgical skills in oncologic procedures including breast and abdominal surgery are acquired. After finishing the fellowship, the gynecologic oncologist should be capable to indicate, plan and perform medical and surgical treatments in cancerous diseases of the breast and the female genital tract. Moreover, it is essential for gynecologic oncologists to understand and include multidisciplinary treatment strategies in cooperation with radiotherapists, general surgeons and medical oncologists to achieve optimal results for their cancer patients     

Problems of sigmoid diverticulitis in the female and its differential diagnostic delineation from the left-sided adnexal tumor]

In the last three years 42 patients with complicated diverticulitis were treated surgically. There were 18 women in all. Nine of these women were believed to have gynecologic disease because of the palbable pelvic tumor and were hospitalized at the Gynecologic Department. 2 patients underwent an exploratory operation by gynecologic surgeons based upon preoperative diagnosis of ovarian mass. The diagnosis at operation in all two cases was perforated sigmoid diverticulitis. Another three of the nine patients had initally emergency exploratory operations by gynecologic surgeons based upon diagnosis of pelvic mass. Also here the diagnosis at operations were perforated sigmoid diverticulitis and they underwent emergency primary resection of the perforated sigmoid by surgeons. In all the cases of complicated diverticulitis the surgical proceature was the primary resection; the anterior resection was combined with a temporare transverse colostomy.--Diverticulitis is an important differential diagnosis of a left pelvic tumor in women with or without clinical and laboratory indications of infections and history of diverticulitis.     

Defining practice patterns in gynecologic oncology to prevent pulmonary embolism and deep venous thrombosis

OBJECTIVE: The goal of venous thromboembolism (VTE) prophylaxis is to reduce the morbidity and mortality associated with the development of a deep venous thrombosis (DVT) or pulmonary embolism (PE). Because women with gynecologic cancers are at high risk to develop VTE, we sought to determine the present practice patterns of gynecologic oncologists regarding their use of VTE prophylaxis. METHODS: 1073 members of the Society of Gynecologic Oncologists (SGO) were mailed surveys that asked about preferred methods to prevent the development of VTE after gynecologic oncology surgery. Data were collected by online member entry and return mail. Frequency distributions were calculated and nonparametric test used for comparisons. RESULTS: 343/1073 (34%) of SGO members and fellows responded. 142/343 (42%) preferred double prophylaxis consisting of external pneumatic compression (EPC) and an anticoagulant while 41% (n=141) preferred EPC with no additional anticoagulation. Of respondents choosing any anticoagulant, 40% preferred Enoxaparin pre- and/or postoperatively. Ovarian cancer patients were perceived by respondents to have the highest risk of developing a postoperative PE. CONCLUSIONS: Most respondents agree that women with gynecologic cancers undergoing major surgery should receive VTE prophylaxis, though there is not agreement as to which method is optimal. While 42% of members preferred double prophylaxis, 41% chose no additional measures other than EPC. Randomized studies in gynecologic oncology should be initiated in the United States to determine the optimal practice pattern.     

Upper extremity deep vein thrombosis associated with indwelling peripheral venous catheters in gynecology oncology patients

OBJECTIVE: The goal of this study was to review the clinical presentation, management, and outcome of upper extremity deep vein thrombosis (UEDVT) in women with gynecologic malignancies who had indwelling peripheral venous access catheters. METHODS: From a retrospective review of medical records, we identified 13 patients with various gynecologic malignancies who were diagnosed with UEDVT during their disease course. We obtained tumor data, detailed information regarding the indwelling catheters used, and the diagnosis and management of UEDVT. RESULTS: Two hundred sixty-four women with gynecologic malignancies underwent insertion of an indwelling peripheral catheter by interventional radiology over a 5-year period. A total of 325 catheters were placed in these patients. Thirteen patients developed UEDVTs, and all had a catheter in situ at the time of DVT diagnosis. Eleven of thirteen patients had Peripheral Access System (PAS) Ports and two had peripheral indwelling central catheters (PICCs). The mean age of the patients was 53 years (range, 32-70). At the time of UEDVT diagnosis patients had the following: progressive cancer (n = 8), stable disease (n = 1), no evaluable disease (n = 4), and actively receiving chemotherapy (n = 7). Clinical signs/symptoms at the time of diagnosis included: catheter occlusion (n = 2), arm swelling and pain (n = 10), and superior vena cava syndrome (n = 1). Diagnosis of thrombosis was confirmed using Doppler ultrasound (n = 4), venography (n = 5), and both modalities (n = 4). Management of UEDVT consisted of anticoagulation with warfarin (2-6 months) (n = 9), urokinase infusion (n = 2), intravenous antibiotics for 21 days and heparin for 10 days (n = 1), arm elevation only (n = 1), Lovenox for 60 days (n = 1), and no therapy (n = 1). There were no complications associated with anticoagulation. No patient had a pulmonary embolism. The incidence of UEDVT among our patients with indwelling venous catheters was 5.7%. CONCLUSION: Symptomatic UEDVT is an uncommon complication of indwelling peripheral venous catheters in women with gynecologic malignancies. The risk of pulmonary embolism is low in this patient population.