低分子肝素具有生物利用度高、半衰期长、不良反应少、使用方便等优点,被广泛应用于妇科肿瘤术后预防下肢静脉血栓形成。但在临床中发现有部分人群使用后出现皮下淤斑,大部分在停药后能自行消退。该文报道一例49岁女性患者,宫颈癌术后使用低分子肝素抗凝,致严重皮肤坏死,并继发窦道形成。该例患者诊断为宫颈中分化鳞癌IB3期,术后因并发下肢深静脉血栓形成,使用依诺肝素钠注射液抗凝共14 d,停药近1个月后出现右下腹淤斑肿块,考虑皮肤坏死,经换药处理7个月方愈。该例提示在使用依诺肝素过程中应注意其皮肤坏死不良反应。

Low-molecular-weight heparin has multiple advantages of high bioavailability, long half-life, few side effects and convenient use, which has been widely applied in the prevention of lower limb venous thrombosis after gynecologic tumor surgery. However, in clinical practice, partial patients present with subcutaneous ecchymosis induced by drug use. Most of them can regress spontaneously after terminating drug use. In this article, a 49-year-old female patient, who was diagnosed with cervical cancer, developed severe skin necrosis and secondary sinus formation caused by use of low-molecular-weight heparin after cervical cancer surgery. She was diagnosed with cervical cancer（IB3 FIGO stage G2）, and treated with enoxaparin sodium injection for 14 d because of deep venous thrombosis of the lower limbs. At 1 month after withdrawal of drug use, she presented with plaque mass in the lower abdomen. The possibility of skin necrosis was considered, which was cured by the ostomyist for 7 months. This case prompts that the risk of skin necrosis should be considered during use of enoxaparin.