Baksaas S T, Geiran O R, Iversen S
Thoraxkirurgisk avdeling Hjerte- og lungeklinikken Rikshospitalet 0027 Oslo.
Tidsskr Nor Laegeforen. 2001 Feb 10;121(4):431-3.
Chronic lung thromboembolism may develop after episodes of acute lung emboli. Instead of being resoluted, the thromboembolic material is incorporated into the walls of the lung arteries causing obstruction of the blood flow. Secondarily, pulmonary hypertension develops and patients experience increasing dyspnoea on exertion. In chronic pulmonary thromboembolism, drug therapy is of little benefit. Surgical thromboendarterectomy of lung arteries has emerged as an effective treatment for these very sick patients.
This paper discusses our experience with seven patients who underwent pulmonary thromboendarterectomy during the five-year period 1995-99 at our institution. The preoperative and postoperative haemodynamic evaluation of all patients were similar.
For five patients the working capacity was significantly improved, one had limited symptomatic effect, and one died perioperatively due to massive surgical bleeding.
Pulmonary thromboendarterectomy may be indicated in selected patients with severe dyspnoea due to pulmonary hypertension secondary to chronic pulmonary thromboembolism.
慢性肺血栓栓塞症可能在急性肺栓塞发作后发生。血栓栓塞物质未被溶解，而是融入肺动脉壁，导致血流阻塞。继而会发展为肺动脉高压，患者会出现运动时呼吸困难加重的症状。在慢性肺血栓栓塞症中，药物治疗收效甚微。肺动脉血栓内膜剥脱术已成为治疗这类重症患者的有效方法。
本文讨论了1995年至1999年期间在我们机构接受肺动脉血栓内膜剥脱术的7例患者的治疗经验。所有患者术前和术后的血流动力学评估相似。
5例患者的工作能力显著提高，1例症状改善有限，1例在围手术期因大量手术出血死亡。
对于因慢性肺血栓栓塞继发肺动脉高压而出现严重呼吸困难的特定患者，可考虑行肺动脉血栓内膜剥脱术。
