Stalpaert G, Suy R, Daenen W, Flameng W, Sergeant P, Nevelsteen A, Lauwers P, De Geest H, Van Elst F
Acta Chir Belg. 1986 Mar-Apr;86(2):118-22.
Between 1970 and 1984 the diagnosis of acute, massive lung embolism was made 30 times in our department. In 29 patients the clinical diagnosis was correct and a Trendelenburg operation under extra-corporeal circulation was performed. In 18 cases there was an operation in the immediate preoperative course. In 1 case there was a combination of operation and the use of contraceptives. 3 cases were immobilized by a plaster of Paris cast. In 4 cases the use of oral contraceptives and in 3 patients the history of chronic recurrent lung embolism were evident. The mean immobilisation time was 15 days. In 24 cases the diagnosis was made only on the base of the clinical anamnesis, and examination, E.C.G. and chest radiography. In 4 cases angiography and in 1 patient the scintigraphy confirmed the diagnosis. Preoperatively 28 patients were in severe shock. One patient was operated electively. 14 patients needed external cardiac massage. In all cases clots were found in the left pulmonary artery, 28 in the right pulmonary artery, in 3 cases clots in the right atrium, 3 in the right ventricle and three in the inferior caval vein. Nine De Weese caval vein clips were inserted and one Mobin-Uddin filter. Postoperatively 18 patients were alive and well without sequelae. Two patients developed a cerebro-vascular accident (CVA) with one complete recovery. Ten patients died. Postoperative treatment consisted of I.V. heparin administration immediately after surgery and 6 months of oral anticoagulants. Except for chronic recurrent lung embolism the pulmonary function tests were excellent postoperatively without recurrence of the disease.
1970年至1984年间，我科共诊断出30例急性大面积肺栓塞。29例患者临床诊断正确，并在体外循环下进行了特伦德伦伯卧位手术。18例在术前即刻进行了手术。1例患者手术与使用避孕药同时存在。3例患者使用巴黎石膏固定。4例患者使用口服避孕药，3例患者有慢性复发性肺栓塞病史。平均固定时间为15天。24例仅根据临床病史、检查、心电图和胸部X线检查做出诊断。4例通过血管造影、1例通过闪烁扫描术确诊。术前28例患者处于严重休克状态。1例患者择期手术。14例患者需要体外心脏按摩。所有病例中，左肺动脉均发现血栓，右肺动脉发现28处血栓，3例右心房有血栓，3例右心室有血栓，3例下腔静脉有血栓。插入了9个德威斯腔静脉夹和1个莫宾 - 乌丁滤器。术后18例患者存活且情况良好，无后遗症。2例患者发生脑血管意外（CVA），其中1例完全康复。10例患者死亡。术后治疗包括术后立即静脉注射肝素以及6个月的口服抗凝剂治疗。除慢性复发性肺栓塞外，术后肺功能测试结果良好，疾病未复发。
