Yasuura Yoshiyuki, Kayata Hiroyuki, Konno Hayato, Kojima Hideaki, Mizuno Tetsuya, Isaka Mitsuhiro, Ohde Yasuhisa
Department of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Thorac Cardiovasc Surg. 2023 Oct;71(7):589-594. doi: 10.1055/s-0043-1761274. Epub 2023 Feb 3.
Pulmonary vein stump thrombosis may occur after left upper lobectomy (LUL) and is a potential risk factor for cerebral infarction. However, there are few reports on the role of pulmonary vein stump thrombosis in the development of cerebral infarction. We aimed to clarify the correlation between pulmonary vein stump thrombosis and cerebral infarction following LUL.
We evaluated 296 patients who underwent contrast-enhanced computed tomography (CT) after LUL for lung cancer at the Shizuoka Cancer Center Hospital in Shizuoka, Japan, between September 2002 and December 2015. The cerebral infarction in patients with pulmonary vein stump thrombosis was examined, and the risk factors for cerebral infarction were identified via a univariate analysis of the clinicopathological and surgical variables.
Overall, 179 men and 117 women (median age: 68 years; range: 36-88 years) were included. The median observation period was 68 months. Pulmonary vein stump thrombosis occurred in 21 (7%) patients and cerebral infarction occurred in 15 (5%) patients. None of the 21 patients with pulmonary vein stump thrombosis developed cerebral infarction. Most cerebral infarctions (12/15) were diagnosed in the late phase (> 3 months). The pathological stage of cancer was found to be the only significant risk factor for cerebral infarction by the univariate analysis.
Pulmonary vein stump thrombosis following LUL was not necessarily associated with cerebral infarction, including the late phase. A prospective observational study with contrast-enhanced chest CT would be required to investigate the risk factors for cerebral infarction in each phase of the postoperative period.
左上肺叶切除术后可能发生肺静脉残端血栓形成，这是脑梗死的一个潜在危险因素。然而，关于肺静脉残端血栓形成在脑梗死发生中的作用的报道较少。我们旨在阐明左上肺叶切除术后肺静脉残端血栓形成与脑梗死之间的相关性。
我们评估了2002年9月至2015年12月期间在日本静冈癌症中心医院因肺癌接受左上肺叶切除术后行对比增强计算机断层扫描（CT）的296例患者。检查了肺静脉残端血栓形成患者的脑梗死情况，并通过对临床病理和手术变量的单因素分析确定脑梗死的危险因素。
共纳入179例男性和117例女性（中位年龄：68岁；范围：36 - 88岁）。中位观察期为68个月。21例（7%）患者发生肺静脉残端血栓形成，15例（5%）患者发生脑梗死。21例肺静脉残端血栓形成患者均未发生脑梗死。大多数脑梗死（12/15）在晚期（> 3个月）被诊断出来。单因素分析发现癌症的病理分期是脑梗死的唯一显著危险因素。
左上肺叶切除术后肺静脉残端血栓形成不一定与脑梗死相关，包括晚期。需要进行一项前瞻性观察研究，采用对比增强胸部CT来调查术后各阶段脑梗死的危险因素。
