肺动脉血栓性动脉内膜切除治疗慢性血栓栓塞性肺高压——德国美茵茨大学医院的经验

PULMONARY THROMBOENDARTERECTOMY FOR CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: THE EXPERIENCE OF THE UNIVERSITY HOSPITAL OF MAINZ

自1989年5月至1991年9月期间,32例慢性肺动脉血栓栓塞性肺高压(CT-PH)患者(男15例,女17例;平均年龄38±15岁;心功能Ⅲ级22例,Ⅳ级10例)在深低温停循环下,施行双侧肺动脉血栓性动脉内膜切除术(PTE)。手术死亡率21.9%(7/32)。主要死亡原因为再灌注肺水肿及肺动脉梗阻解除不完全。25例存活者心功能明显改善。15例随诊17±5月,效果良好。作者认为,CT-PH患者施行PTE治疗可获良好效果,但早期诊断、早期手术却是重要的。

From May 1989 to Sept. 1991, 82 patients (male 15, female 17, mean age 38±15 years, NYHA class Ⅲ/Ⅳ: 22/10) with chronic thromboembolic pulmonary hypertension (CT-PH) underwent bilateral pulmonary thromboendarterectomy (PTE) under CPB, deep hypothermia, and periods of total circulatory arrest in the University Hospital of Mainz. The operative mortality rate was 21.9% (7/32). Pulmonary reperfusion edema or incomplete relief of pulmonary obstruction was the main cause of death. In the 25 survivors, cardiac function was improved markedly. 17±5 months follow-up of 15 cases revealed satisfactory results. The authors believe that (1) PTE can be performed with excellent long term results in patients with CT-PH; (2) early diagnosis and early surgical treatment are important for these patients.