Miyoshi Ryo, Nishikawa Shigeto, Tamari Shigeyuki, Noguchi Misa, Hijiya Kyoko, Chihara Koji
1 Department of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
2 Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
Asian Cardiovasc Thorac Ann. 2018 Sep;26(7):546-551. doi: 10.1177/0218492318802141. Epub 2018 Sep 14.
Objectives Thrombosis in the pulmonary vein stump after a left upper lobectomy is a rare but potentially life-threatening complication, and the pulmonary vein stump length plays an important role here. We assessed the frequency and risk factors for thrombosis in patients undergoing lobectomy with division of the superior pulmonary vein using ligation. Methods We retrospectively reviewed 425 patients with primary lung cancer who underwent lobectomy or bilobectomy in our institution from 2008 to 2016, with contrast-enhanced chest computed tomography within a year after lobectomy. The superior pulmonary vein was divided by thread ligation, while the inferior pulmonary vein was divided using a linear stapler. The pulmonary vein stump length was measured using contrast-enhanced chest computed tomography. Results Four (0.9%) of the 425 patients experienced thrombosis in the pulmonary vein stump within 6 months after lobectomy. All 4 patients had undergone a left upper lobectomy, and 4.1% of this subset developed thrombus. One patient with a thrombus in the pulmonary vein stump experienced renal and cerebral infarction after a left upper lobectomy. The left superior pulmonary vein stump was significantly longer than the other pulmonary vein stumps. Conclusions Thrombosis in the pulmonary vein stump occurred in 4.1% of patients undergoing a left upper lobectomy with pulmonary vein stump closure by thread ligation, which is a relatively low frequency. Superior pulmonary vein stump closure using thread ligation might help prevent pulmonary vein stump thrombus after a left upper lobectomy.
目的 左上肺叶切除术后肺静脉残端血栓形成是一种罕见但可能危及生命的并发症，肺静脉残端长度在此过程中起重要作用。我们评估了采用结扎法离断肺上静脉的肺叶切除患者中血栓形成的发生率及危险因素。方法 我们回顾性分析了2008年至2016年在我院接受肺叶切除术或双肺叶切除术的425例原发性肺癌患者，这些患者在肺叶切除术后一年内接受了胸部增强计算机断层扫描。肺上静脉采用丝线结扎离断，肺下静脉采用直线切割缝合器离断。通过胸部增强计算机断层扫描测量肺静脉残端长度。结果 425例患者中有4例（0.9%）在肺叶切除术后6个月内发生肺静脉残端血栓形成。所有4例患者均接受了左上肺叶切除术，该亚组中有4.1%发生血栓。1例肺静脉残端血栓形成患者在左上肺叶切除术后发生肾梗死和脑梗死。左上肺静脉残端明显长于其他肺静脉残端。结论 在采用丝线结扎闭合肺静脉残端的左上肺叶切除患者中，肺静脉残端血栓形成的发生率为4.1%，这一发生率相对较低。采用丝线结扎闭合肺上静脉残端可能有助于预防左上肺叶切除术后肺静脉残端血栓形成。
