肺栓塞的诊断:妇科肿瘤学中螺旋CT肺动脉造影术的应用经验

作     者：Martino M.A. Williamson E. Siegfried S. 刘亦恒 

作者机构：Department of Obstetrics and Gynecology University of South Florida Harbourside Medical Towers 4 Columbia Drive Tampa FL 33606 United States 

出 版 物：《世界核心医学期刊文摘（妇产科学分册）》 (Core Journal in Obstetrics/Gynecology)

年 卷 期：2005年第1卷第11期

页      面：42-43页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：妇科肿瘤学 动脉造影术 肺栓塞 妇科肿瘤患者 癌症诊断 存活者 列联表 诊断评价 模型校正 年死亡率 

摘      要：Objectives. To review our experience with the diagnosis and prognosis of pulmonary embolism (PE) in gynecologic oncology patients. Methods. Spiral CT pulmonary angiography (CTPA) studies on gynecologic oncology patients were collected from our radiology database from 6/2001 to 6/2003. Patient charts were retrospectively reviewed. Data were abstracted relative to presenting symptoms, demographics and laboratory and diagnostic evaluations. Patient data were compared using chi-square contingency tables and logistic regression analysis. Survival was studied using the Kaplan-Meier method and the log rank test. The effect of PE on survival was adjusted using a proportional hazards regression model. Results. One-hundred and eleven CTPA studies were performed over 2 years and 25 patients were diagnosed with *** PE (n = 25) and non-PE (n = 86) groups were similar for age, race, BMI and cancer diagnosis. Tachycardia (P = 0.02, OR = 3.03 95% CI 1.16-7.94 ) and leukocytosis (P = 0.04, OR = 2.93 95% CI 1.05-8.18 ) were more frequent among PE patients and confirmed as independently prognostic of *** other clinical and laboratory findings were similar between patients with and without PE. Overall survival for patients with and without PE was 63% versus 94% , respectively, at 2 years (P = 0.02). Conclusion. In a gynecologic oncology patient with high clinical suspicion for PE, our clinical pre-test probability was 23.0% . Two-year mortality rates were 6-fold higher for patients diagnosed with PE. The significant overlap in clinical presentations, multiple risk factors and higher mortality rates encourage the aggressive diagnosis and treatment of PE among this population. Further work is needed to reduce the incidence and mortality rate of PE.