Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark.
Scand Cardiovasc J. 2012 Jun;46(3):172-6. doi: 10.3109/14017431.2011.642811. Epub 2012 Mar 27.
Surgical embolectomy for acute pulmonary embolism (PE) is considered to be a high risk procedure and therefore a last treatment option. We wanted to evaluate the procedures role in modern treatment of acute PE.
All data on patients treated with surgical embolectomy for acute PE were retrieved from our clinical database. The mortality was extracted from the Danish mortality register.
From October 1998 to July 2010, 33 patients underwent surgical embolectomy. All procedures were done through a median sternotomy and extracorporeal circulation. Twenty-six patients were diagnosed with a high risk PE and 7 with an intermediate risk PE and intracardial pathology. Six patients had been insufficiently treated with thrombolysis. Thirteen patients had contraindication for thrombolysis. Six patients were brought to the operating theatre in cardiogenic shock, 8 needed ventilator support, and 1 was in cardiac arrest. The postoperative 30-day mortality was 6% and during the 12-year follow-up the cumulative survival was 80% with 4 late deaths.
Surgical pulmonary embolectomy can be performed with low mortality although the treated patients belong to the most compromised part of the PE population. The results support surgical embolectomy as a vital part of the treatment algorithm for acute PE.
急性肺栓塞（PE）的外科取栓术被认为是一种高风险的手术，因此是最后的治疗选择。我们希望评估该手术在急性 PE 现代治疗中的作用。
从我们的临床数据库中检索了所有接受外科取栓术治疗急性 PE 的患者的数据。死亡率从丹麦死亡率登记处提取。
1998 年 10 月至 2010 年 7 月，33 名患者接受了外科取栓术。所有手术均通过正中胸骨切开术和体外循环进行。26 例患者被诊断为高危 PE，7 例为中危 PE 并伴有心内病理。6 例患者溶栓治疗不充分。13 例患者有溶栓禁忌证。6 例患者在心源性休克时被送到手术室，8 例需要呼吸机支持，1 例心脏骤停。术后 30 天死亡率为 6%，12 年随访期间累积生存率为 80%，有 4 例晚期死亡。
尽管接受治疗的患者属于 PE 人群中最脆弱的一部分，但外科肺栓塞取栓术可以在低死亡率的情况下进行。这些结果支持外科取栓术作为急性 PE 治疗算法的重要组成部分。
