MDT discussion of a patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Kaiguang ¹ ,  GUAN Quanlin ^1,2 , ZHAO Yongxun ¹ , ZHAO Peng ¹

1. Department of Surgical Oncology, The First Affiliated Hospital of Lanzhou University, Lanzhou 730030, P. R. China;
2. Key Laboratory of Gastrointestinal Diseases in Gansu, Lanzhou 730030, P. R. China;

Corresponding author：

GUAN Quanlin, Email: guanquanlin@163.com

Keywords：

breast cancer; acute pulmonary thromboembolism; radical mastectomy; MDT

DOI：

10.7507/1007-9424.201809050

Video：

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Objective To summarize the treatment measures and experience for one patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer. Methods The discussion on MDT (multi-disciplinary team) of a breast cancer patient admitted to The First Hospital of Lanzhou University in March 2018 and the results of the discussion on acute pulmonary thromboembolism after operation were summarized. Results This patient had many high risk factors for deep venous thrombosis of the lower extremities, such as obesity, advanced age, hypertension, malignant tumor, and surgical stress. The operative time was about 90 min and the blood loss was 30 mL, without nerve and vascular injuries. Acute pulmonary thromboembolism occurred suddenly on 10 days after operation, which led to heart failure. Eventually, the patient died of the peripheral circulatory insufficiency caused by respiratory failure and heart failure. Conclusion Surgeons should pay great attention to the perioperative management of the patients with many high-risk factors, who may occur acute pulmonary thromboembolism caused by deep venous thrombosis of lower limbs after radical mastectomy.

Citation： ZHANG Kaiguang, GUAN Quanlin, ZHAO Yongxun, ZHAO Peng. MDT discussion of a patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1502-1506. doi: 10.7507/1007-9424.201809050 Copy

1.	中华医学会心血管病学分会肺血管病学组, 中国医师协会心血管内科医师分会. 急性肺血栓栓塞症诊断治疗中国专家共识. 中华内科杂志, 2010, 49(1): 74-81.
2.	张金山, 毛哲玉, 周俊伟, 等. 乳腺癌术后并发急性肺栓塞 1 例报道. 临床肺科杂志, 2016, 21(1): 187-188.
3.	Kenyon N, Zeki AA, Albertson TE, et al. Definition of critical asthma syndrome. Clin Rev Allergy Immuno1, 2015, 48(1): 1-6.
4.	Tran BH, Nguyen TJ, Hwang BH, et al. Risk factors associated with venous thromboembolism in 49,028 mastectomy patients. Breast, 2013, 22(4): 444-448.
5.	任立军, 杨延芳, 孙清慧, 等. 乳腺癌术后并发急性肺栓塞 4 例分析. 中国医师进修杂志, 2007, 30(17): 78.
6.	Khan UT, Walker AJ, Baig S, et al. Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis. BMC Cancer, 2017, 17(1): 747.
7.	Walker AJ, West J, Card TR, et al. When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data. Blood, 2016, 127(7): 849-857.
8.	蒲纯, 许小毛, 乔力松, 等. 恶性肿瘤并发静脉血栓栓塞症的临床分析. 中华老年多器官疾病杂志, 2016, 15(11): 810-814.
9.	Xu J, Li F, Chang F. Correlation of the ultrasound imaging of breast cancer and the expression of molecular biological indexes. Pak J Pharm Sci, 2017, 30(4 Suppl): 1425-1430.
10.	Hou XY, Niu HY, Huang XL, et al. Correlation of breast ultrasound classifications with breast cancer in Chinese women. Ultrasound Med Biol, 2016, 42(11): 2616-2621.
11.	Chiorean AR, Szep MB, Feier DS, et al. Impact of Strain Elastography on BI-RADS classification in small invasive lobular carcinoma. Med Ultrason, 2018, 20(2): 148-153.
12.	刘卓, 李晓凤, 张美云. Apaf-1 和 Ki-67 在乳腺癌组织中的表达及临床意义. 临床肿瘤学杂志, 2017, 22(2): 133-136.
13.	王宁, 刘金彪. 乳腺癌患者深静脉血栓形成的临床分析. 中国医药, 2014, 9(7): 1037-1039.
14.	蒲纯, 许小毛, 乔力松, 等. 恶性肿瘤并发静脉血栓栓塞症的临床分析. 中华老年多器官疾病杂志, 2016, 15(11): 810-814.
15.	唐振宁, 王博, 刘奇伦, 等. 乳腺癌合并静脉血栓栓塞症临床分析. 宁夏医科大学学报, 2015, 37(9): 1060-1062.
16.	Chew HK, Wun T, Harvey D, et al. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med, 2006, 166(4): 458-464.
17.	Wun T, White RH. Venous thromboembolism (VTE) in patients with cancer: epidemiology and risk factors. Cancer Invest, 2009, 27(Suppl 1): 63-74.
18.	Galanaud JP, Quenet S, Rivron-Guillot K, et al. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost, 2009, 7(12): 2028-2034.
19.	程显声. 肺栓塞防治研究的现状与展望. 中华心血管病杂志, 2001, 29(5): 257-258.
20.	方奕鹏, 关键, 陆艳辉, 等. 急诊肺栓塞初诊与误漏诊病例的临床特点对比研究. 临床误诊误治, 2017, 30(10): 35-40.
21.	Schwarz T, Buschmann L, Beyer J, et al. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg, 2010, 52(5): 1246-1250.
22.	盛招云. 乳腺癌术后下肢功能锻炼预防深静脉血栓形成. 护理与康复, 2006, 5(1): 69-70.
23.	Autar R. NICE guidelines on reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients undergoing surgery. J Orthop Nurs, 2007, 11(3): 169-176.
24.	Patiar S, Kirwan CC, McDowell G, et al. Prevention of venous thromboembolism in surgical patients with breast cancer. Br J Surg, 2007, 94(4): 412-420.
25.	罗德光, 黄云飞. 乳腺癌围手术期肺栓塞猝死 1 例分析. 中国肿瘤临床与康复, 2002, 9(1): 104.
26.	刘毓, 马榕. 乳腺癌术后下肢深静脉血栓形成的危险因素及预防. 国际外科学杂志, 2014, 41(3): 214-216.

1. 中华医学会心血管病学分会肺血管病学组, 中国医师协会心血管内科医师分会. 急性肺血栓栓塞症诊断治疗中国专家共识. 中华内科杂志, 2010, 49(1): 74-81.
2. 张金山, 毛哲玉, 周俊伟, 等. 乳腺癌术后并发急性肺栓塞 1 例报道. 临床肺科杂志, 2016, 21(1): 187-188.
3. Kenyon N, Zeki AA, Albertson TE, et al. Definition of critical asthma syndrome. Clin Rev Allergy Immuno1, 2015, 48(1): 1-6.
4. Tran BH, Nguyen TJ, Hwang BH, et al. Risk factors associated with venous thromboembolism in 49,028 mastectomy patients. Breast, 2013, 22(4): 444-448.
5. 任立军, 杨延芳, 孙清慧, 等. 乳腺癌术后并发急性肺栓塞 4 例分析. 中国医师进修杂志, 2007, 30(17): 78.
6. Khan UT, Walker AJ, Baig S, et al. Venous thromboembolism and mortality in breast cancer: cohort study with systematic review and meta-analysis. BMC Cancer, 2017, 17(1): 747.
7. Walker AJ, West J, Card TR, et al. When are breast cancer patients at highest risk of venous thromboembolism? A cohort study using English health care data. Blood, 2016, 127(7): 849-857.
8. 蒲纯, 许小毛, 乔力松, 等. 恶性肿瘤并发静脉血栓栓塞症的临床分析. 中华老年多器官疾病杂志, 2016, 15(11): 810-814.
9. Xu J, Li F, Chang F. Correlation of the ultrasound imaging of breast cancer and the expression of molecular biological indexes. Pak J Pharm Sci, 2017, 30(4 Suppl): 1425-1430.
10. Hou XY, Niu HY, Huang XL, et al. Correlation of breast ultrasound classifications with breast cancer in Chinese women. Ultrasound Med Biol, 2016, 42(11): 2616-2621.
11. Chiorean AR, Szep MB, Feier DS, et al. Impact of Strain Elastography on BI-RADS classification in small invasive lobular carcinoma. Med Ultrason, 2018, 20(2): 148-153.
12. 刘卓, 李晓凤, 张美云. Apaf-1 和 Ki-67 在乳腺癌组织中的表达及临床意义. 临床肿瘤学杂志, 2017, 22(2): 133-136.
13. 王宁, 刘金彪. 乳腺癌患者深静脉血栓形成的临床分析. 中国医药, 2014, 9(7): 1037-1039.
14. 蒲纯, 许小毛, 乔力松, 等. 恶性肿瘤并发静脉血栓栓塞症的临床分析. 中华老年多器官疾病杂志, 2016, 15(11): 810-814.
15. 唐振宁, 王博, 刘奇伦, 等. 乳腺癌合并静脉血栓栓塞症临床分析. 宁夏医科大学学报, 2015, 37(9): 1060-1062.
16. Chew HK, Wun T, Harvey D, et al. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med, 2006, 166(4): 458-464.
17. Wun T, White RH. Venous thromboembolism (VTE) in patients with cancer: epidemiology and risk factors. Cancer Invest, 2009, 27(Suppl 1): 63-74.
18. Galanaud JP, Quenet S, Rivron-Guillot K, et al. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost, 2009, 7(12): 2028-2034.
19. 程显声. 肺栓塞防治研究的现状与展望. 中华心血管病杂志, 2001, 29(5): 257-258.
20. 方奕鹏, 关键, 陆艳辉, 等. 急诊肺栓塞初诊与误漏诊病例的临床特点对比研究. 临床误诊误治, 2017, 30(10): 35-40.
21. Schwarz T, Buschmann L, Beyer J, et al. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg, 2010, 52(5): 1246-1250.
22. 盛招云. 乳腺癌术后下肢功能锻炼预防深静脉血栓形成. 护理与康复, 2006, 5(1): 69-70.
23. Autar R. NICE guidelines on reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients undergoing surgery. J Orthop Nurs, 2007, 11(3): 169-176.
24. Patiar S, Kirwan CC, McDowell G, et al. Prevention of venous thromboembolism in surgical patients with breast cancer. Br J Surg, 2007, 94(4): 412-420.
25. 罗德光, 黄云飞. 乳腺癌围手术期肺栓塞猝死 1 例分析. 中国肿瘤临床与康复, 2002, 9(1): 104.
26. 刘毓, 马榕. 乳腺癌术后下肢深静脉血栓形成的危险因素及预防. 国际外科学杂志, 2014, 41(3): 214-216.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT discussion of a patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer

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