Uno Y, Horikoshi S, Emoto H, Koyanagi K
Department of Cardiovascular Surgery, Kashiwa Hospital, Tokyo Jikei University School of Medicine, Chiba, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Oct;44(10):1958-61.
A 35-year-old woman was bedridden because of a fall and developed pulmonary embolism after venous thromboembolism of lower extremity. Although anticoagulation therapy was immediately carried out, hemodynamics deteriorated gradually into the state of class IV in Green-field's classification. As a result, an urgent surgical procedure was performed. Under moderate hypothermic cardio-pulmonary bypass, the aorta was cross-clamped and the pulmonary artery was opened. An 18 gram clot was taken out directly and other small pieces of clot were removed with a fiberscope, a Fogarty catheter and an aspirating tube. After surgery the patient recovered from symptoms efficiently. Some cases of acute pulmonary thromboembolism have been reported, however, the generalized classification and surgical indication for this disease have not been established yet. But, as all of reports mentions, surgical procedure is recommended positively to these cases that resist anticoagulation therapy.
一名35岁女性因跌倒卧床，下肢静脉血栓形成后发生肺栓塞。尽管立即进行了抗凝治疗，但血流动力学逐渐恶化为格林菲尔德分类中的IV级状态。结果，进行了紧急手术。在中度低温体外循环下，阻断主动脉并切开肺动脉。直接取出一块18克的血栓，并用纤维镜、Fogarty导管和吸引管清除其他小块血栓。术后患者症状有效缓解。虽然已有一些急性肺血栓栓塞的病例报道，但该病的通用分类和手术指征尚未确立。但是，正如所有报道所提及的，对于对抗凝治疗有抵抗的病例，积极推荐手术治疗。
