Sadeghi Allreza, Brevetti Gregory R, Kim Sanghyun, Burack Joshua H, Genovese Mark H, Distant Dale A, Kodavatiganti Ramesh, Lowery Robert C
Department of Surgery, State University of New York-Downstate Medical Center, Brooklyn, New York 11203-2098, USA.
Tex Heart Inst J. 2005;32(3):430-3.
We present the case of a 72-year-old woman who had an acute massive pulmonary embolism after abdominal surgery. The patient had undergone a right hemicolectomy and pancreaticoduodenectomy for locally invasive colonic adenocarcinoma. Six hours postoperatively, she required emergent intubation when she suddenly became cyanotic, severely hypotensive, and tachypneic, with an oxygen saturation of 50%. An acute massive pulmonary embolism was suspected, and an emergency transesophageal echocardiogram confirmed the diagnosis. On the basis of the patient's clinical condition and the echocardiographic findings, we performed an emergent pulmonary embolectomy, with the patient on cardiopulmonary bypass. We evacuated multiple large clots from both pulmonary arteries. The patient recovered and was discharged from the hospital 61 days postoperatively. Herein, we review the current literature on open surgical pulmonary embolectomy. This case supports the use of open pulmonary embolectomy for the treatment of hemodynamically unstable patients on the basis of clinical diagnosis. We discuss the role of emergent transesophageal echocardiography in the diagnosis and management of massive pulmonary embolism.
我们报告一例72岁女性患者，其在腹部手术后发生急性大面积肺栓塞。该患者因局部浸润性结肠腺癌接受了右半结肠切除术和胰十二指肠切除术。术后6小时，当她突然出现发绀、严重低血压和呼吸急促，血氧饱和度为50%时，需要紧急插管。怀疑发生急性大面积肺栓塞，紧急经食管超声心动图确诊。根据患者的临床状况和超声心动图检查结果，我们在患者体外循环下进行了紧急肺栓子切除术。我们从双侧肺动脉中取出了多个大血栓。患者康复，术后61天出院。在此，我们回顾了目前关于开放性手术肺栓子切除术的文献。该病例支持基于临床诊断对血流动力学不稳定的患者使用开放性肺栓子切除术。我们讨论了紧急经食管超声心动图在大面积肺栓塞诊断和管理中的作用。
