肺癌术后急性肺动脉栓塞的诊治体会

Diagnosis and treatment of acute pulmonary thromboembolism in postoperative patients with lung cancer

目的通过分析肺癌患者术后急性肺动脉栓塞的临床特点，探讨其诊断、治疗和预防策略。方法对1990—2002年开胸手术的1245例原发肺癌，发生急性肺动脉栓塞、并需要心肺复苏的14例，对其临床资料进行回顾性分析。讨论不典型病例的临床特点，并提出了快速诊断和治疗的方案。结果所有病例即使立即采用了心肺复苏，仍有8例（57．1％）死亡；其余6例存活。此6例均接受抗凝治疗，其中3例采用溶栓治疗。2例有巨大肺动脉栓子经急诊手术治疗得以治愈。结论肺动脉栓塞是肺切除术后早期较少见、但致命的并发症。治疗应根据患者的不同状态和不同手段的优缺点综合因素决定。

Objective To analyze the characteristics of acute pulmonary thromboembelism （APE） in postoperative patients with primary lung cancer, and to investigate the strategies for prevention, early diagnosis, and prompt treatment of this catastrophic disease after thoracotomy.Methods 1 245 cases of primary lung cancer undergoing thoracotomy between January. 1990 and December 2002 were retrospectively reviewed. Clinical data of a total of 14 patients suffering from acute pulmonary thrombeembelism and requiring cardiopulmonary resuscitation were collected and analyzed. Results Even using prompt resuscitation, 8 patients （57.1% ） died after the onset of the symptoms, whereas 6 eventually recovered.AU the 6 Surviving patients,received anticoagulation therapy,including 3 cases of additional thrombelytic therapy. Two cases having massive pulmonary embeli received emergency surgery, with satisfactory results. Conclusions Acute pulmonary thrombeembolism is an infrequent but fatal early postoperative complication after lung resection. The therapeutic strategies should be based on a careful evaluation of the expected benefits and risks of the various available treatments.