Tahara K, Sueda T, Shikata H, Orihashi K, Mitsui N, Matsuura Y
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Nov;43(11):1875-8.
We report a case treated with thromboembolectomy using cardiopulmonary bypass for acute pulmonary embolism caused by nephrotic syndrome. A 19-year-old male with poorly controlled nephrotic syndrome was admitted associating with severe shock. An acute pulmonary embolism was diagnosed by ECG and echocardiography. Despite the intensive thrombolytic therapy, hemodynamics was deteriorated. Pulmonary arteriography demonstrated obstruction of left main pulmonary artery and partial defects of right pulmonary artery bifurcation and right middle-lower pulmonary arteries. An emergent thromboembolectomy using cardiopulmonary bypass was performed successfully. In conclusion, an emergent surgical treatment is required in the case of acute massive pulmonary thromboembolism which shows hemodynamic deterioration in spite of recent intensive medical treatment.
我们报告了一例采用体外循环下血栓切除术治疗的肾病综合征所致急性肺栓塞病例。一名19岁男性，肾病综合征控制不佳，因严重休克入院。通过心电图和超声心动图诊断为急性肺栓塞。尽管进行了强化溶栓治疗，但血流动力学仍恶化。肺动脉造影显示左主肺动脉阻塞，右肺动脉分叉及右中下肺动脉部分缺损。成功实施了体外循环下的急诊血栓切除术。总之，对于尽管近期进行了强化内科治疗但仍出现血流动力学恶化的急性大面积肺血栓栓塞病例，需要进行急诊手术治疗。
