国际妇产科学杂志

国际妇产科学杂志 ›› 2015, Vol. 42 ›› Issue (5): 579-582.

• 综述 • 上一篇    下一篇

预防性抗凝治疗在妇科恶性肿瘤中的应用

陈吉牟，狄文   

  1. 200127 上海交通大学医学院附属仁济医院妇产科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-10-15 发布日期:2015-10-15
  • 通讯作者: 狄文

Thromboprophylaxis in Gynecologic Cancer

CHEN Ji-mou，DI Wen   

  1. Department of Obstetrics and Gynecology，Renji Hospital，School of Medicine，Shanghai Jiaotong University，Shanghai 200127，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-10-15 Online:2015-10-15
  • Contact: DI Wen

PDF (PC)

4877

摘要： 恶性肿瘤通过多种机制激活凝血系统，引起高凝状态。高凝状态也能促进肿瘤细胞的增殖和转移。高凝状态易形成静脉血栓栓塞（venous thromboembolism，VTE），VTE是恶性肿瘤常见的并发症，能直接导致患者死亡。妇科恶性肿瘤患者是发生VTE的高危人群。VTE是影响肿瘤患者生存率的重要因素。目前，临床指南推荐传统开腹手术患者术后立即进行最长达28 d的预防性抗凝治疗。对于进行微创手术的妇科肿瘤患者和术后进行化疗的患者，是否常规进行预防性抗凝治疗存在争议，仍需根据患者具体情况进行综合分析。肝素具有一定的抗肿瘤作用，但长期使用预防性抗凝治疗对恶性肿瘤患者预后的影响仍待进一步研究。

关键词: 生殖器肿瘤, 女（雌）性, 抗凝药, 肝素, 低分子量, 静脉血栓形成, 静脉血栓栓塞, 肺栓塞

Abstract: Tumor cell can stimulate the procoagulant activity and induce a hypercoagulable state. This tumor hypercoagulability contributes to tumor growth, tumor metastasis and formation of venous thromboembolism. Women with a gynecologic malignancy are considered at high risk of venous thromboembolism (VTE). Studies demonstrated that VTE negatively impacted patients′ survival. Current guidelines recommend up to 28 days′ VTE thromboprophylaxis in the immediate postoperative period for patients undergoing open surgery. There are no established guidelines for women undergoing minimally invasive gynecologic surgery and chemotherapy. Appropriate prophylactic therapy should be considered according to each patient′s condition. Heparin is considered to have anti-tumor effect. Whether prolonged thromboprophylaxis can improve patients′ survival needs further investigation.

Key words: Genital neoplasms, female, Anticoagulants, Heparin, low-molecular-weight, Venous thrombosis, Pulmonary embolism