Hara H, Aoyagi S, Hirata Y, Akashi H, Koga M, Aso K, Fujino T, Tashiro T, Kosuga K, Ohishi K
Second Department of Surgery, Kurume University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Apr;38(4):573-8.
The records of 6 patients undergoing pulmonary embolectomy for massive pulmonary embolism (MPE) at Kurume University Hospital during 17 years were reviewed to determine the management of surgery. The patients consisted of 2 men and 4 women. The patients' ages ranged from 29 to 68 years (mean age, 49.3 years). The records showed that one patient died of brain death after operation and the others survived. All the patients complained of chest pain, anterior chest discomfort and dyspnea. Sudden syncope was observed in 2 patients. Artificial mechanical ventilation was performed preoperatively on 3 patients. Right ventricular load was demonstrated on electrocardiograms and ultrasonograms. Pulmonary angiograms were attempted on two patients and one of them had cardiac arrest during this examination. MPE was suspected by perfusion defect of 50% to 80% of pulmonary vasculature demonstrated on lung perfusion scintigram in 4 patients. Open pulmonary embolectomy with cardiopulmonary bypass (CPB) was performed on all patients using crystalloid cardioplegia and topical cooling. Intraoperative pulmonary angiograms were performed in 4 patients to prevent residual thromboemboli. Since most thromboemboli originate below the level of the vena cava, acute double ligation of the vena cava just below the renal vein was performed to control recurrent embolism. Oral anticoagulant, warfarin, was administered for 3 months after embolectomy as prophylaxis against postoperative recurrent embolism. It is our opinion that an aggressive attitude toward pulmonary embolectomy on CPB is necessary to save lives of MPE patients. This surgical procedure is very easy and safe.
回顾了久留米大学医院17年间6例因大面积肺栓塞（MPE）接受肺血栓切除术患者的病历，以确定手术管理情况。患者包括2名男性和4名女性。患者年龄在29至68岁之间（平均年龄49.3岁）。病历显示，1例患者术后死于脑死亡，其他患者存活。所有患者均主诉胸痛、胸前区不适和呼吸困难。2例患者出现突然晕厥。3例患者术前进行了人工机械通气。心电图和超声心动图显示右心室负荷增加。对2例患者进行了肺血管造影，其中1例在检查期间发生心脏骤停。4例患者肺灌注闪烁显像显示肺血管50%至80%灌注缺损，怀疑为MPE。所有患者均采用晶体心脏停搏液和局部降温，在体外循环（CPB）下进行开放性肺血栓切除术。4例患者术中进行了肺血管造影，以防止残留血栓栓塞。由于大多数血栓栓塞起源于腔静脉水平以下，因此在肾静脉下方立即对腔静脉进行急性双重结扎，以控制复发性栓塞。肺血栓切除术后口服抗凝剂华法林3个月，以预防术后复发性栓塞。我们认为，对CPB下的肺血栓切除术采取积极态度对于挽救MPE患者的生命是必要的。这种手术操作非常简单且安全。
