Thrombosis in the Pulmonary Vein Stump After Left Upper Lobectomy as a Possible Cause of Cerebral Infarction
Thrombosis in the Pulmonary Vein Stump After Left Upper Lobectomy as a Possible Cause of Cerebral Infarction
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DOI：
10.1016/j.athoracsur.2013.03.005
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发表时间：
2013-06-01
影响因子：
4.6
通讯作者：
Matsui, Yoshiro
中科院分区：
文献类型：
--
作者：
Ohtaka, Kazuto;Hida, Yasuhiro;Matsui, Yoshiro
背景。肺静脉残端血栓（PV）并不是肺切除术后常见的并发症，它有可能导致重要器官的栓塞。为了明确这种并发症的发生频率、危险因素和原因，我们对接受肺叶切除术的患者进行了回顾性临床研究。该研究评估了2005年至2011年期间接受肺叶切除术并在肺叶切除术后2年内进行胸部CT增强扫描的193例原发性肺癌患者。回顾性分析对比增强CT检查PV残端是否有血栓。其中右上叶切除65例，右中叶切除14例，右下叶切除40例，左上叶切除52例，左下叶切除22例。193例患者中有7例（3.6%）在肺叶切除术后左心室残端出现血栓。所有血栓患者均行LUL，其中13.5%的患者发生血栓。单因素分析显示，LUL和手术时间是重要的危险因素，辅助化疗是次要的。血栓似乎与左心室残端长度有关。利用三维CT图像测量左上节段残端长度，发现左上节段残端比其他残端长。13.5%的患者发生左心室残端血栓。这些发现表明，应该推荐LUL后的患者进行对比增强CT检查，以帮助识别血栓栓塞的高风险患者。(C) 2013年由胸外科学会发布
Background. Thrombus in the stump of the pulmonary vein (PV) is not a well-known complication after lung resection, and it has the potential to cause embolism to vital organs. To clarify the frequency, risk factors, and cause of this complication, a retrospective clinical study of patients who underwent lobectomy was performed.Methods. The study evaluated 193 patients with primary lung cancer who underwent lobectomy from 2005 to 2011 and contrast-enhanced chest computed tomography (CT) within 2 years after lobectomy. Contrast-enhanced CT was retrospectively interpreted to check for thrombus in the PV stump.Results. The operative procedures were 65 right upper lobectomies, 14 right middle lobectomies, 40 right lower lobectomies, 52 left upper lobectomies (LUL), and 22 left lower lobectomies. Thrombus developed in the PV stump in 7 of the 193 patients (3.6%) after lobectomy. All patients with thrombus had undergone LUL, and 13.5% of those who had undergone LUL developed thrombus. Univariate analyses revealed that LUL and operation time were significant risk factors and that adjuvant chemotherapy was marginally significant. It appears that thrombus may be attributable to the length of the PV stump. Measurement of the length of the PV stump using 3-dimensional CT images of the PV revealed that the stump of the left superior PV was longer than the others.Conclusions. Thrombus in the PV stump occurred in 13.5% of patients after LUL. These findings suggest that contrast-enhanced CT should be recommended for patients after LUL to help identify those with a high risk for thromboembolism. (C) 2013 by The Society of Thoracic Surgeons