AKCÝÐER KANSERLERÝNDE ALT EKSTREMÝTE DERÝN VEN TROMBOZU ÝNSÝDANSININ RENKLÝ DOPPLER ULTRASONOGRAFÝ ÝLE ARAÞTIRILMASI

Tromboembolik hastalýk kanser hastalarýnda mortalite ve morbiditeyi etkileyen önemli faktörlerden biridir. Kanser hastalarýnda ikinci sýklýkta ölüm nedeni trombozdur. Çalýþmamýzda akciðer kanseri tanýsý konan hastalarda taný anýnda alt ekstremite derin ven trombozu görülme sýklýðýnýn renkli doppler ultrasonografi ile saptanmasý amaçlandý. Akciðer kanseri tanýsý alan 50 hasta semptomlar, eþlik eden hastalýk, venöz tromboemboliye predispozisyon yaratan durumlar açýsýndan sorgulandý. Radyolojik, bronkoskopik ve sitopatolojik özellikleri tespit edildi. Evreleri, tedavi rejimleri ve metastaz yerleri saptandý. Toplam 16 hastada eþlik eden hastalýk tespit edildi. Bir hasta kolon tümörü nedeniyle opere olmuþtu. Dördü kadýn, ikisi erkek olmak üzere 6 hastanýn dýþýnda tüm hastalar sigara içiyordu. Koagülasyon testleri 8 hastada bozulmuþtu. 15 hastada trombositoz saptanýrken sadece bir hastada polisitemi saptandý. Arteryel kan gazlarýnda; 17 hastada hipoksi, 8 hastada hiperkapni gözlendi. Patolojik olara k 10 hasta küçük hücreli, 38 hasta küçük hücreli dýþý akciðer kanseri, 2 hasta ise indiferan karsinom tanýsý aldý. Bir hasta evre IIA, 2 hasta evre IIB, bir hasta evre IIIA, 22 hasta evre IIIB ve 14 hasta evre IV olarak deðerlendirildi. Çalýþmada yer alan tüm hastalara alt ekstremite renkli doppler ultrasonografi incelemesi yapýldý; hepsinde bilateral alt ekstremite derin venöz sistemi patent olarak izlendi, tromboze görünüm saptanmadý. Bu çalýþmada, henüz tedavi uygulanmamýþ olan akciðer kanserli hastalarda derin ven trombozunun klinik bulgularý olmadan, rutin olarak tarama amaçlý alt ekstremite renkli doppler ultrasonografi incelemesinin gerekli olmadýðý sonucuna varýldý. Bu konuda daha geniþ hasta gruplarýnda yapýlan çalýþmalara gerek vardýr.

INVESTIGATION OF INCIDENCE OF LOWER EXTREMITY DEEP VENOUS THROMBOSIS IN LUNG CANCER BY COLOUR DOPPLER ULTRASONOGRAPHY

Thromboembolic disease is one of the important factors affecting mortality and morbidity in cancer patients. Thrombosis is the second cause of mortality in lung cancer. In this study, it was purposed to determine the incidence of lower extremity deep venous thrombosis in patients with lung cancer at the time of diagnosis by color doppler ultrasonography. Fifty patients, who had been diagnosed as lung cancer, were selected randomisely regardless of clinical symptoms. Cases were asked about factors enhancing risk of thrombosis; comorbidity, history of drugs, operations, smoking, thromboembolic diseases. Cases had comorbidity 32%, history of smoking 88%, history of operation 2%, abnormal coagulation tests 16%, thrombocytosis 30% and polycytemia 2%. In analysis of arteriel blood gases cases exhibited hypoxemia 34%, hypercapnia 16%. In histopathologic examination of bronchoscopic or transthorasic biopsy materials cases were classified as small cell lung cancer 20%, nonsmall cell lung cancer 76% and indifferent carcinoma 4%. In order to determine the stage of the disease, vascular and mediastinal involvement were investigated by thorax computed tomography or magnetic resonans imaging, metastases were investigated by abdominal tomography or ultrasonography. Stage IIA was 2%, stage IIB was 4%, stage IIIA was 2%, stage IIIB 44 % and stage IV was 28%. Lower extremity color doppler ultrasonography exhibited that bilaterally lower extremity deep venous systems were found to be intact in all cases, no thrombosis was shown. In this study it was concluded that searching of lower extremity by color doppler ultrasonography routinely was not necessary in absence of clinical features of deep venous thrombosis. Further researches are needed in wider patient populations about this subject.