胸腔镜肺癌根治术后早期并发高危肺栓塞介入溶栓治疗经验

Experience of Interventional Thrombolysis Therapy for Massive Pulmonary Thrombosis Embolism after Video-assisted Thoracoscopic Surgery for Lung Cancer

背景与目的肺栓塞(pulmonary thrombosis embolism, PTE)是肺癌根治术围术期严重并发症之一,其中高危PTE因伴有休克、低血压具有病情进展快、死亡率高的特点。这类患者的治疗目前尚无统一标准,是胸外科医生临床工作中的难点。本文通过总结分析我院2例肺癌术后早期并发高危PTE患者的治疗过程,探讨此类病例的诊疗策略,为广大胸外科医生提供参考。方法分析2017年在我院接受胸腔镜肺癌根治手术术后早期并发高危PTE患者两例。1例予静脉联合肺动脉介入溶栓治疗,1例予单纯肺动脉介入溶栓治疗。总结分析两例病人治疗效果及治疗过程中出现的并发症。结果 2例患者均为女性,年龄分别为66岁、61岁,发生PTE的时间分别为术后48 h、45h,接受介入溶栓时间分别是发病后70 min、50 min,介入治疗时间分别是120 min、100 min,介入溶栓后引流分别是4,690 mL、520 mL,溶栓后住院时间分别是21 d、14 d,随访6个月均无明显并发症。结论肺癌术后早期发生高危PTE建议尽早行肺动脉内介入溶栓治疗,相对于静脉溶栓治疗,肺动脉内介入溶栓具有给药精准、药物用量容易控制、疗效快、出血风险小等优点。

Background and objective Pulmonary thrombosis embolism （PTE） is one of the most severe compli- cations of perioperative radical mastectomy. Massive PTE is often accompanied by shock and hypotension which is character- ized by rapid progression and high mortality. There is no standard for the treatment of these patients, which is thoracic surgery, and it is a critical issue in the thoracic surgeons. This article summarizes and analyzes the treatment of two patients with high- risk PTE at the early stage of postoperative lung cancer in our hospital. In addition, we discusses the diagnosis and treatment strategies of these cases to provide a reference for the thoracic surgeons. Methods We presented two patients with high-risk PTE at the early stage after thoracic surgery for radical surgery in our hospital back in 2017. One case was treated with intra- venous venous interventional thrombolysis, and the other was treated with thrombolysis alone. The treatment effect of two patients and the complications during the treatment has been recorded to detail and summarized. Results Both patients were female who aged 66 and 61 years old. The time point of pulmonary embolism was 48 h and 45 h after operation, and the time of interventional thrombolysis was 70 minutes and 50 minutes after onset respectively. After 120 minutes and 100 minutes, the drainage after interventional thrombolysis was 4,690 mL and 520 mL respectively. The hospitalization time after thrombolysis was 21 days and 14 days respectively. There was no obvious complication through a follow-up of 6 months. Conclusion Early postoperative acute massive pulmonary embolism in lung cancer should be treated with pulmonary interventional thromboly- sis as soon as possible. Compared with intravenous thrombolysis, pulmonary interventional thrombolysis shows accuracy, easy controlling of dosage, fast curative effect and low bleeding risk.