成功介入溶栓治疗胃癌并发上肢深静脉血栓形成一例

The Successful Treatment of Thrombosis in Upper Limb DeepVein with Thrombolytic Intervention in One Gastric TumorCase

摘要: 病人男性，58岁，因“胃癌化疗后1年半，左上肢肿胀2天”入院。查体：双侧颈部未及肿大淋巴结，左颈部肿胀，左上肢肿胀，左肘上8 cm周径32 cm，左肘下8 cm周径31 cm，右肘上、下周径28 cm。左上肢无触痛，血运良好。辅助检查：血常规：白细胞：4.8 × 109/l，血小板：113 × 109/l，凝血四项均在正常范围，B超显示左颈内静脉和左锁骨下静脉血栓形成。入院后在手术室局麻下于左肘部切开一3 cm皮肤切口，找到贵要静脉，穿刺置入中心静脉导管，注入造影剂证实左侧自腋静脉开始有血栓形成，置入1.5米超滑导丝至上腔静脉，然后带入多功能导管，分别于锁骨下静脉和颈内静脉内注入稀释后的重组人组织型纤溶酶原衍生物18 mg，于血栓远心端造影示左锁内下静脉和左颈内静脉已通畅，撤走导管，缝合贵要静脉穿刺孔，溶栓结束，回病房后给予抗凝、祛聚，2天后病人左上肢肿胀明显减轻。 A 58 years old patient, male, presented left upper limb swelling for two days, one and a half years after chemotherapeutical treatment of gastric tumor. Physical examination results: No cervical lymph node swelling was found on both sides; left side neck was swollen; left upper limb was swollen with circumference 32 cmand31 cmat8 cmabove and below the left elbow, respectively; the circumference above and below the right elbow was28 cm. No touch pain was found and blood supply showed normal on the left upper limb. Laboratory examination results: For blood test, WBC was 4.8 × 109/l, blood platelets 113 × 109/l; four blood coagulation indexes were normal; ultrasound B scan showed thrombosis formation at the left jugular vein and left subclavian vein. After admission a local anesthesia was applied to the patient and a3 cmskin incision was made at the left elbow level. The basilic vein was located and a central venous catheter was inserted and implanted. An injection of contrast media was carried out to confirm the thrombosis formation from left axillary vein. A 1.5 meter long super smooth guide wire was inserted into the superior vena cava, followed with a multi-functional catheter. A dose of 18 mg diluted recombinant human tissue-type plasminogen derivatives was injected at the subclavian vein and the internal jugular vein, respectively. After an angiography at the distal site of vein thrombotic showed re-open at the left subclavian vein and the internal jugular vein, the catheter was removed and the incision at the basilic vein was sutured. In the ward the patient was followed with anticoagulant and antiplatelet adhesion treatments. After two days, the swelling of the patient’s left upper limb was significantly reduced.