电视胸腔镜肺叶切除术后急性肺动脉栓塞的诊断与治疗

目的探讨电视胸腔镜(VATS)肺叶切除术后急性肺动脉栓塞(pulmonary embolism,PE)的诊断、治疗及其预防措施。方法 2007年1月至2010年11月广州医学院第一附属医院对1 115例肺癌患者施行电视胸腔镜肺叶切除术,术后发生急性PE 13例,男6例,女7例;平均年龄62.3(42～73)岁。所有患者均经胸部螺旋CT肺动脉造影(SCTPA)确诊,均接受低分子肝素和华法林抗凝治疗。结果电视胸腔镜肺叶切除术后急性PE发生率为1.17%(13/1 115),低危患者比例高(11/13),发生右侧PE 12例,接受抗凝治疗后症状均缓解,有9例患者复查SCTPA显示栓塞消失或明显吸收,无胸腔出血、伤口渗血等并发症;随访1～3个月均未发现复发。结论电视胸腔镜肺叶切除术后发生急性PE的诊断首选SCTPA检查,需采用适当的预防和治疗措施;术后PE发生率低,低危比例高,体现了微创外科手术的优势。

Diagnosis and Treatment for Acute Pulmonary Embolism after Video-assisted Thoracoscopic Lobectomy

Objective To investigate strategies for prevention,early diagnosis,and prompt treatment for acute pulmonary embolism(PE) after video-assisted thoracoscopic surgery(VATS) lobectomy. Methods From January 2007 to November 2010,1 115 patients with lung cancer underwent VATS lobectomy in the First Affiliated Hospital of Guangzhou Medical College.Among them,13 patients had acute PE postoperatively,including 6 male patients and 7 female patients with their mean age of 62.3 years(ranging from 42 to 73 years).All the patients were diagnosed by spiral CT pulmonary artery angiography(SCTPA),and received anticoagulation therapy with low molecular weight heparin and warfarin.Results The incidence of acute PE after VATS lobectomy was 1.17%(13/1 115),and the patients with low PE-related early mortality risk accounted for a large proportion(11/13).There were 12 patients with right-side PE.All the patients’ signs and symptoms were significantly alleviated after administration of anticoagulation therapy.Nine patients received SCTPA review after treatment which showed that their PE had disappeared or been significantly absorbed.No hematological complications including thoracic hemorrhage or wound errhysis occurred after treatment.All surviving patients were followed up for 1 month to 3 months.During follow-up,these patients were alive without PE recurrence. Conclusion SCTPA is the first-choice examination for the diagnosis of acute PE after VATS lobectomy.Prophylaxis against PE and prompt treatment are necessary depending on individual manifestations.VATS lobectomy should be favored as a minimally invasive surgical treatment for patients with lung cancer,for the low incidence of postoperative PE and low PE-related early mortality risk.