Kataoka D, Kadokura M, Nonaka M, Yamamoto S, Kawada T, Takaba T
First Department of Surgery, Showa University School of Medicine, Tokyo, Japan.
Kyobu Geka. 2002 Dec;55(13):1157-60.
Acute pulmonary thromboembolism is fatal if the diagnosis and treatments are delayed. Here we present a case of acute thromboembolism to the right and left pulmonary arteries after right lung lobar resection. A 52-year-old woman who admitted to our hospital with lung cancer was performed right upper lobectomy with mediastinal lymph node dissection (pT1N0M0, well differentiated adenocarcinoma). Two days after surgery, she complained sudden chest discomfort and dyspnea. The blood pressure and oxygen saturation were rapidly decreased. Because there was no lung edema or atelectasis in the chest portable roentgenogram and no ischemic change in the electrocardiogram, pulmonary thromboembolism was suspected and emergency chest computed tomography (CT) was performed. The CT showed left and right pulmonary arterial thromboembolism and immediate anti-coagulator therapy was started. Her condition was improved and chest CT, which was performed three days after the onset of the thromboembolism, showed decreased but still remained thrombus. The anti-coagulator therapy was continued and one month after the onset of the thromboembolism, thrombus was disappeared on chest CT. She is doing well 17 months after surgery. Early diagnosis and treatments are critical for the pulmonary thromboembolism.
如果诊断和治疗延迟,急性肺血栓栓塞是致命的。在此,我们报告一例右肺叶切除术后发生左右肺动脉急性血栓栓塞的病例。一名因肺癌入住我院的52岁女性接受了右上叶切除并纵隔淋巴结清扫术(pT1N0M0,高分化腺癌)。术后两天,她突然出现胸部不适和呼吸困难。血压和血氧饱和度迅速下降。由于胸部便携式X线片未见肺水肿或肺不张,心电图未见缺血性改变,怀疑为肺血栓栓塞,遂行急诊胸部计算机断层扫描(CT)。CT显示左右肺动脉血栓栓塞,立即开始抗凝治疗。她的病情有所改善,血栓栓塞发生三天后进行的胸部CT显示血栓减少但仍存在。继续抗凝治疗,血栓栓塞发生一个月后,胸部CT显示血栓消失。术后17个月她情况良好。早期诊断和治疗对肺血栓栓塞至关重要。