Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
Department of Cerebrovascular and Neurological Diseases, Osaka International Cancer Institute, Osaka, Japan.
World J Surg. 2024 Sep;48(9):2090-2097. doi: 10.1002/wjs.12309. Epub 2024 Aug 7.
It has recently been suggested that the formation of pulmonary vein stump thrombus (PVST) after anatomical lung resection is an underlying cause of arterial thromboembolism including cerebrovascular infarction. This study aimed to investigate the incidence and risk factors of PVST and to evaluate the efficacy and safety of anticoagulant therapy for PVST.
Patients who underwent anatomical lung resection for malignant lung tumors were eligible for inclusion in this study. Chest contrast-enhanced (CE) computed tomography (CT) was performed after surgery to detect PVST. If PVST was observed, patients received anticoagulant therapy. The size of the PVST was followed-up by repeated chest CE-CT.
In total, 176 patients were enrolled in this study. Chest CE-CT was performed on postoperative day 1-13 (median, postoperative day 6). PVST was detected in 22 (12.5%) patients. The median size of PVST was 9.5 (4.1-33.4) mm. Thrombus was most commonly observed in patients who underwent left upper lobectomy (9/36, 25.0%). Hypertension, dyslipidemia, arteriosclerosis, and arrhythmia were not associated with PVST formation. Anticoagulant therapy was administered to all 22 patients with PVST until the PVST disappeared. The median duration between the detection and disappearance of PVST was 77 days (range: 6-146 days). During the period between the detection and disappearance of PVST, cerebrovascular infarction or arterial thromboembolic events were not observed.
Postoperative PVST is commonly observed, especially in patients who undergo left upper lobectomy. Anticoagulant therapy for PVST was safely introduced and was efficient to improve PVST without subsequent arterial thromboembolic events.
最近有人提出，解剖性肺切除术后肺静脉残端血栓（PVST）的形成是包括脑血管梗死在内的动脉血栓栓塞的潜在原因。本研究旨在探讨 PVST 的发生率和危险因素，并评估抗凝治疗 PVST 的疗效和安全性。
本研究纳入了因恶性肺肿瘤接受解剖性肺切除术的患者。术后行胸部增强（CE）计算机断层扫描（CT）以检测 PVST。如果观察到 PVST，患者接受抗凝治疗。通过重复胸部 CE-CT 对 PVST 的大小进行随访。
共有 176 例患者纳入本研究。术后第 1-13 天行胸部 CE-CT（中位时间，术后第 6 天）。22 例（12.5%）患者检测到 PVST。PVST 的中位大小为 9.5（4.1-33.4）mm。血栓最常见于行左上肺叶切除术的患者（9/36，25.0%）。高血压、血脂异常、动脉硬化和心律失常与 PVST 形成无关。所有 22 例 PVST 患者均接受抗凝治疗，直至 PVST 消失。PVST 检测到消失的中位时间为 77 天（范围：6-146 天）。在 PVST 检测到消失期间，未观察到脑血管梗死或动脉血栓栓塞事件。
术后 PVST 很常见，尤其是在接受左上肺叶切除术的患者中。对 PVST 进行抗凝治疗是安全有效的，可改善 PVST，且无后续动脉血栓栓塞事件发生。
