Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, 330-8503, Japan.
Department of Surgery, Jichi Medical University, 1-3311 Yakusiji, Shimono, Tochigi, Saitama, 329-0498, Japan.
BMC Anesthesiol. 2019 Feb 23;19(1):27. doi: 10.1186/s12871-019-0695-9.
There are several recent reports that left upper lobe lung resection is a risk factor for the development of postoperative thromboembolism. Although administering epidural analgesia is common in thoracic surgery, anesthesiologists should be alert when administering epidural analgesia to a patient undergoing left upper lobectomy, considering the increased risk of postoperative thromboembolism and the potential need for anticoagulation or fibrinolytic therapy in the immediate postoperative period.
A seventy-one-year-old female with a metastatic lung lesion developed a cerebral infarction approximately 30 h after video-assisted thoracoscopic left upper lobectomy. Cerebral intravascular therapy was indicated and the epidural catheter was removed immediately to avoid formation of an epidural hematoma. Approximately four hours after onset, reperfusion was successfully established by aspiration of endovascular thrombi. She recovered with mild residual paralysis of the left upper extremity and was transferred to a rehabilitation facility.
We present a patient with a cerebral infarction after left upper lobectomy. Left upper lobectomy is associated with an increased risk of postoperative thromboembolism. Although the exact mechanism of thrombosis after left upper lobectomy is unclear, a judicious decision should be made regarding epidural catheter placement for postoperative analgesia.
有几项近期的报告指出，左上肺叶切除术是术后血栓栓塞形成的一个危险因素。尽管在胸部手术中使用硬膜外镇痛较为常见，但在为接受左上肺叶切除术的患者施行硬膜外镇痛时，麻醉师应保持警惕，因为术后血栓栓塞形成的风险增加，并且在术后即刻可能需要抗凝或溶栓治疗。
一名 71 岁女性，患有转移性肺病变，在接受电视辅助胸腔镜下左上肺叶切除术约 30 小时后发生脑梗死。需要进行脑血管内治疗，立即将硬膜外导管拔出，以避免硬膜外血肿形成。发病后约 4 小时，通过抽吸血管内血栓成功建立再灌注。她左侧上肢轻度瘫痪残留，恢复后转至康复机构。
我们报告了一例左上肺叶切除术后发生脑梗死的患者。左上肺叶切除术与术后血栓栓塞形成的风险增加相关。尽管左上肺叶切除术后发生血栓的确切机制尚不清楚，但应谨慎决定术后镇痛时硬膜外导管的放置。
