Eisenmann B, Jeanblanc B, Baehrel B, Kurtz T, Kieny M T, Kieny R
Arch Mal Coeur Vaiss. 1977 Jun;70(6):573-9.
The authors report 26 pulmonary embolectomies carried out successfully, 10 of them having been Trendelenberg procedures and 16 having been carried out under extracorporeal circulation. The latter method gives better results, and appears to be the procedure of choice. The haemodynamics before operation were always abnormal, and there were 4 cardiac arrests, 11 cases of severe shock, and 6 cases with less severe hypotension. In the other cases, cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. It was possible to carry out arteriography in 14 cases, and this showed extensive pulmonary vascular obstruction in between 70 and 90%. In 4 cases this procedure was followed by an exacerbation, and extremely urgent treatment became neccessary. This examination is important for diagnosis and for assessment of the prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe pulmonary embolus. The essential indications for surgery are moribund patients, those in whom fibrinolysis is contraindicated or unsuccessful, and those with massive obstruction of the pulmonary arterial tree.
作者报告了26例成功实施的肺动脉血栓切除术，其中10例采用特伦德伦伯格手术，16例在体外循环下进行。后一种方法效果更好，似乎是首选的手术方式。术前血流动力学总是异常的，有4例心脏骤停，11例严重休克，6例轻度低血压。在其他病例中，发绀、呼吸窘迫和急性肺心病体征是大块栓子的临床特征。14例可行动脉造影，结果显示70%至90%的患者存在广泛的肺血管阻塞。4例患者在该检查后病情加重，急需治疗。该检查对诊断和预后评估很重要。作者认为，与严重预后的药物溶栓治疗一样，手术有一定的地位。作者认为，与严重肺栓塞的药物溶栓治疗一样，手术有一定的地位。手术的主要指征是濒死患者、溶栓治疗禁忌或失败的患者以及肺动脉树严重阻塞的患者。
