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目的:探讨肺癌患者开胸术后发生急性肺动脉栓塞的临床特点,以及诊断、治疗和预防的策略。方法:回顾性分析1996年1月～2002年12月1245例开胸手术的原发性肺癌患者(其中14例发生急性肺动脉栓塞且需要心肺复苏)的临床资料。结果:急性肺动脉栓塞的发生率为1.1%(14/1245),其中9例(64.3%)通过临床表现及间接检查确诊;4例(28.6%)通过直接检查确诊,包括肺通气/灌注扫描2例,螺旋CT增强扫描1例和肺动脉造影1例;尸检1例。所有病例即使立即采用了心肺复苏,仍有8例(57.1%)在症状出现48h(平均4h)内死亡;6例(42.9%)得以生存,均静脉应用肝素和口服华法令抗凝治疗,其中3例采用了尿激酶溶栓治疗。2例有巨大肺动脉栓子的患者经急诊手术治疗,1例行栓子摘除术,1例行右肺中下叶切除术,术后效果均满意。结论:肺动脉栓塞是肺切除术后早期较少见、致命的并发症,诊断主要依靠临床表现和间接检查。直接的检查手段包括肺核素扫描、螺旋CT增强扫描和肺血管造影,应在患者状态稳定后进行。治疗策略应根据患者的状态和治疗手段的优缺点来综合决定。
Objective: To investigate the clinical features of acute pulmonary embolism after thoracotomy in patients with lung cancer, as well as the strategies of diagnosis, treatment and prevention. Methods: The clinical data of 1245 patients with primary lung cancer undergoing thoracotomy (including 14 patients with acute pulmonary embolism and needing cardiopulmonary resuscitation) were retrospectively analyzed from January 1996 to December 2002. Results: The incidence of acute pulmonary embolism was 1.1% (14/1245), of which 9 (64.3%) were confirmed by clinical manifestations and indirect examinations. Four patients (28.6%) were confirmed by direct examination including pulmonary ventilation / perfusion scan 2 Cases, spiral CT enhanced scan in 1 case and pulmonary angiography in 1 case; autopsy in 1 case. Eight patients (57.1%) died of symptoms within 48h (mean 4h) despite CPR immediately; 6 (42.9%) survived intravenously with heparin and oral warfarin, with Three patients treated with urokinase thrombolysis. Two patients with huge pulmonary embolism were treated by emergency surgery. One patient underwent embolectomy and one patient underwent middle and lower right lobe resection. The results were satisfactory. Conclusions: Pulmonary embolism is a rare and fatal complication in the early post-pneumonectomy. The diagnosis mainly depends on clinical manifestations and indirect examination. Direct examination methods include pulmonary radionuclide scan, spiral CT enhanced scan and pulmonary angiography should be carried out in patients with stable state. Treatment strategy should be based on the status of patients and the advantages and disadvantages of treatment to comprehensive decision.