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新型冠状病毒肺炎患者行肺切除术的围手术期管理:来自中国武汉某胸外科的简要报告

Coronavirus Disease 2019 in the Perioperative Period of Lung Resection: A Brief Report From a Single Thoracic Surgery Department in Wuhan, People's Republic of China.

机构信息

Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.

Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.

出版信息

J Thorac Oncol. 2020 Jun;15(6):1065-1072. doi: 10.1016/j.jtho.2020.04.003. Epub 2020 Apr 11.

DOI:10.1016/j.jtho.2020.04.003
PMID:32289516
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7194109/
Abstract

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, People's Republic of China, and has subsequently spread worldwide. Clinical information on patients who contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the perioperative period is limited. Here, we report seven cases with confirmed SARS-CoV-2 infection in the perioperative period of lung resection. Retrospective analysis suggested that one patient had been infected with the SARS-CoV-2 infection before the surgery and the other six patients contracted the infection after the lung resection. Fever, lymphopenia, and ground-glass opacities revealed on computed tomography are the most common clinical manifestations of the patients who contracted COVID-19 after the lung resection. Pathologic studies of the specimens of these seven patients were performed. Pathologic examination of patient 1, who was infected with the SARS-CoV-2 infection before the surgery, revealed that apart from the tumor, there was a wide range of interstitial inflammation with plasma cell and macrophage infiltration. High density of macrophages and foam cells in the alveolar cavities, but no obvious proliferation of pneumocyte, was found. Three of seven patients died from COVID-19 pneumonia, suggesting lung resection surgery might be a risk factor for death in patients with COVID-19 in the perioperative period.

摘要

2019 年冠状病毒病(COVID-19)是一种新发传染病,最初在中国武汉报告,随后在全球范围内传播。围手术期感染严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)的患者的临床信息有限。在这里,我们报告了 7 例在肺切除围手术期确诊 SARS-CoV-2 感染的病例。回顾性分析提示,1 例患者在手术前已感染 SARS-CoV-2 感染,另外 6 例患者在肺切除术后感染。术后感染 COVID-19 的患者最常见的临床表现为发热、淋巴细胞减少和 CT 扫描显示磨玻璃影。对这 7 例患者的标本进行了病理研究。对手术前感染 SARS-CoV-2 感染的患者 1 进行的病理检查显示,除肿瘤外,还存在广泛的间质炎症,伴有浆细胞和巨噬细胞浸润。肺泡腔中有大量的巨噬细胞和泡沫细胞,但肺泡细胞没有明显增生。7 例患者中有 3 例死于 COVID-19 肺炎,提示肺切除术可能是围手术期 COVID-19 患者死亡的一个危险因素。

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