肺癌手术后肺栓塞的处理.pdfVIP

European Journal of Cardio-thoracic Surgery 24 (2003) 580–587 /locate/ejcts Successful management of acute pulmonary embolism after surgery for lung cancer Toru Sakuragi*, Yukinori Sakao, Kojiro Furukawa, Kazuhisa Rikitake, Satoshi Ohtsubo, Yukio Okazaki, Masafumi Natsuaki, Tsuyoshi Itoh Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan Received 28 March 2003; received in revised form 4 June 2003; accepted 12 June 2003 Abstract Objective: Although many case reports of acute pulmonary embolism (APE) have been published, the literature dealing with the management of APE after resection of lung cancer is limited. This report describes seven cases of successful management of APE after surgery for lung cancer and discusses how to manage this problematic complication. Methods: The medical charts of seven patients with APE after lobectomy and complete mediastinal lymphnode dissection were retrospectively reviewed. Results: Six patients collapsed during their first attempt at walking after surgery in conjunction with a dramatic respiratory change. All these patients promptly underwent enhanced spiral computed tomography (CT) scanning. Bilateral clots were detected in all patients and one patient with a deep venous thrombus (DVT) in the femoral vein had a temporary inferior vena cava filter implanted. Non-surgical therapy was used for six patients: thrombolysis (systemic urokinase) and anticoagulant (heparin or argatroban) for four patients and only anticoagulant therapy started on the day after the operation using argatroban for two. There w