Kieny R, Charpentier A, Kieny M T
Department of Cardiovascular Surgery, University of Strasbourg, France.
J Cardiovasc Surg (Torino). 1991 Sep-Oct;32(5):549-54.
From 1.1970 to 31.12.1989, 134 patients with pulmonary embolism were treated by pulmonary embolectomy (74 women and 60 men) of mean age 55 years (23-78 years); 93 (69%) of these patients developed embolism during the postoperative period following surgery for another condition. In 12 cases the embolectomy was performed without circulatory assistance by a modified Trendelenburg operation after an average delay time of 2 hours. In 122 cases, extracorporeal circulation (ECC) was used, preceded in 64 cases, by a femoral-femoral bypass (the average delay interval of operation being 16.9 hours). At operation, 23 patients were in complete circulatory failure needing external cardiac massage, 34 were in cardiogenic shock with systolic arterial pressures (SAP) less than 60 mmHg, 42 maintained their arterial pressure between 60 and 100 mmHg, and only 35 were seen with SAP higher than 100 mmHg under vasopressive drugs. No haemodynamic and angiographic investigations could be undertaken in 31 patients because of their dramatic clinical state. In the other 103 patients who had invasive angiographic investigations performed the pulmonary bed was obstructed from 65% to 90% (mean 79.4%) according to Miller's index. The mean arterial pulmonary pressure was 51.2 mmHg. The survival rate at the 30th postoperative day showed 113 patients were alive (84.3%) with 7 among the 12 operated by the Trendelenburg's modified method and 106 among the 122 operated under ECC. The main causes of the 21 deaths were: peroperative 8, neurological 4, cardiac 4, respiratory 1, recurrent embolism 1, acute thrombosis of the IVC 1. Our results of pulmonary embolectomy can be compared favorably to those obtained by thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)
1970年1月1日至1989年12月31日期间，134例肺栓塞患者接受了肺动脉血栓切除术（74例女性，60例男性），平均年龄55岁（23 - 78岁）；其中93例（69%）患者在因其他病症手术后的术后期间发生了栓塞。12例患者在平均延迟2小时后，通过改良特伦德伦伯格手术在无循环辅助的情况下进行了血栓切除术。122例患者使用了体外循环（ECC），其中64例在股-股旁路术后使用（手术平均延迟间隔为16.9小时）。手术时，23例患者出现完全循环衰竭，需要进行体外心脏按压；34例处于心源性休克，收缩动脉压（SAP）低于60 mmHg；42例患者的动脉压维持在60至100 mmHg之间；只有35例在使用血管加压药物的情况下，SAP高于100 mmHg。31例患者因临床状态危急，未进行血流动力学和血管造影检查。在其他103例接受有创血管造影检查的患者中，根据米勒指数，肺床阻塞率为65%至90%（平均79.4%）。平均肺动脉压为51.2 mmHg。术后第30天的生存率显示，113例患者存活（84.3%），其中12例采用改良特伦德伦伯格方法手术的患者中有7例存活，122例在ECC下手术的患者中有106例存活。21例死亡的主要原因是：术中8例、神经方面4例、心脏方面4例、呼吸方面1例、复发性栓塞1例、下腔静脉急性血栓形成1例。我们的肺动脉血栓切除术结果与溶栓治疗的结果相比具有优势。（摘要截断于250字）
