Trousseau症候群合併卵巢癌：一病例報告

Trousseau's Syndrome in Association with Ovarian Cancer: A Case Report

自從1865年Trousseau發表了靜脈栓塞為癌症併發症之觀點後，癌症和靜脈栓塞的聯結就經常被稱之為Trousseau症候群。癌症合併靜脈栓塞的原因是相當複雜，癌症本身很可能就是最主要危險因子，但其確切機轉仍有待進一步研究。台灣地區十大死因榜首從1982年以來一直就是惡性腫瘤，同時伴隨著老年社會的來臨，癌症和其相關靜脈栓塞個案將會愈來愈多。我們提出一位更年期婦女雖然持續使用口服抗凝劑治療，仍然在3個月內罹患復發性、遷移性下肢靜脈栓塞。病患首次住院時，排除了結締組織、血管炎和血液相關疾病並以Duplex證實了下肢靜脈栓塞。第二次住院時高度懷疑子宮肌瘤和下肢靜脈栓塞相關，所以安排了腹腔鏡協助下經陰道子宮切除。手術後病理報告為兩側漿液性乳頭狀卵巢囊腺癌合併有子宮內膜和子宮體轉移。診斷也修正為Trousseau症候群合併卵巢癌。病患要求轉院。並在他院接受了癌症分期手術、化學治療和爾後相關處置（包括了安寧療護）。4年後病患因多發性轉移而過世。經由文獻探索，我們討論了Trousseau症候群的機轉和抗凝劑使用之策略。希望藉此案例提醒醫療從業人員，於診療復發性下肢靜脈栓塞時，務必要將Trousseau症候群列入鑑別診斷，並睿智地使用抗凝劑治療。

Thrombosis was recognized as a complication of cancer by Trousseau in 1865. Since then the combination of these two conditions is often called Trousseau's syndrome. There are many causes of thrombosis in cancer. Cancer itself is often the major risk factor. But the real mechanisms are still under investigation. Malignancy has been ranked as the leading cause of death in Taiwan since 1982. In association with the aging population of countries, cancer-associated thrombosis may occur more frequently in the near future. We present a postmenopausal woman who suffered from lower left leg venous thrombosis. Intravenous heparin treatment was initially given and later shifted to oral anticoagulant therapy. Within 3 months, the patient experienced a relapse of symptoms, only this time in the right leg. When the patient was first hospitalized, serology tests excluded: collagen disease, vasculitis, and hematologic disorders. Duplex ultrasound confirmed the diagnosis of lower left leg venous thrombosis. During the patient's second hospitalization, coexisting uterine myoma was highly suspected and laparoscopically-assisted vaginal hysterectomy was arranged. After the operation, pathology revealed serous papillary cystadenocarcinoma of bilateral ovaries with metastasis to the endometrium and corpus. We revised the diagnosis to Trousseau's syndrome in association with ovarian cancer. The patient asked to be transferred to another hospital. In the following 4 years, the patient underwent the aforementioned treatment and associated managements including hospice care, but later died due to multiple metastasis. We discuss the mechanisms of Trousseau's syndrome and guidelines regarding the use of anticoagulants in Trousseau's syndrome and cancer patients by literature review. The purpose of this paper is to remind clinicians to consider Trousseau's syndrome as a differential diagnosis of recurrent lower leg venous thrombosis and initiate appropriate anticoagulant therapy.