肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压的临床研究

Clinical study on thromboendarterectomy in the treatment of chronic thromboembolic pulmonary hypertension

目的 探讨肺动脉内膜剥脱术在治疗慢性栓塞性肺动脉高压的效果、诊治经验及手术指证.方法 5例慢性栓塞性肺动脉高压的患者,均在体外循环下行肺动脉切开血栓取出术＋肺动脉内膜剥脱术.结果 本组病人手术过程顺利,无手术死亡,无术后残余肺动脉高压、灌注性肺水肿等并发症,术后病人肺动脉压力和肺血管阻力明显降低,复查心脏彩超均示肺动脉血流通畅,血管管壁光滑,术后顺利出院,术后随访6～12个月,效果满意.结论 肺动脉切开血栓取出术＋肺动脉内膜剥脱术对于慢性栓塞性肺动脉高压的患者,尤其是内科溶栓术无效的患者,有良好的治疗效果.

Objective To investigate the result, diagnosis experience, and surgical indication of the pulmonary thromboendarterectomy（PTE） in the treatment of patients with chronic thromboembolic pulmonary hypertension （CTEPH）. Methods Five CTEPH patients underwent pulmonary endarterectomy and embolectomy under cardiopulmonary bypass. Results All patients underwent PTE successfully without perioperative death or complications like postoperative residual pulmonary or pulmonary perfusion edema. Patients＇ postoperative pulmonary artery pressure and pulmonary vascular resistance（PVR） were significantly reduced, and the reviewed echocardiography showed the pulmonary vascular wall was smooth and without re-embolization. All patients recovered well and were successfully discharged, and the effect of postoperative follow-up of 6 to 12 months was satisfied. Conclusion PTE is an effective treatment for the patients with CTEPH, especially for those with an ineffective medical thrombolysis.