Massive pulmonary embolism: surgical embolectomy versus thrombolytic therapy-should surgical indications be revisited?
Massive pulmonary embolism: surgical embolectomy versus thrombolytic therapy-should surgical indications be revisited?
复制标题
DOI：
10.1093/ejcts/ezs123
复制
发表时间：
2013-01-01
影响因子：
3.4
通讯作者：
Carrel, Thierry
中科院分区：
文献类型：
--
作者：
Aymard, Thierry;Kadner, Alexander;Carrel, Thierry
大面积肺栓塞(PE)的治疗是一个有争议的问题。我们介绍了我们对患有大量PE的患者的机构经验，目的是比较主要分配给肺手术取栓术(SE)和溶栓治疗(TL)的患者的早期结果、结果和生活质量(QOL)。对一组对需要SE的TL反应失败的患者(TS)分别进行分析。所有连续的患者(2001年1月至2007年12月)都接受了CT扫描证实的双侧中央或中心旁大面积PE。所有临床资料均从我们的患者登记处检索，并通过评估CT扫描得出的右室/左室比(RV/LV比)来完成。对80例患者进行分析，包括28例SE(35%)和52例TL(65%)，其中11例(21%)需要TS。SE和TL的人口学特征和术前特征相似。RV/LV比值分析显示SE为1.66，TL为1.44。早期死亡率在两组之间没有显著差异(SE：3.6%对TL：13.5%)，而最初接受溶栓治疗并随后需要SE的患者(TS-组)的早期死亡率为27%。SE组严重出血并发症发生率较低(3.6%比26.5%，P=0.013)。脑内出血率和神经事件在统计学上没有差异。平均随访63+/-21个月，SE组和TL组的死亡率分别为17.9%和23.1%，SE是治疗大面积PE的极佳选择，早期死亡率与TL相当，出血并发症明显少于TL。溶栓无效后接受手术的患者早期结果最差。右室/左室CT扫描比率可作为区分患者的预测指标，这些患者可以从直接手术干预中获益，而不是溶栓治疗。还需要进一步的研究来证实这些结果。
The treatment of massive pulmonary embolism (PE) is a matter of debate. We present our institutional experience of patients suffering from massive PE with the aim of comparing the early results, the outcome and quality of life (QoL) between patients primarily assigned to either pulmonary surgical embolectomy (SE) or thrombolytic therapy (TL). A subgroup of patients (TS) with failed responses to TL requiring SE was separately analysed.All consecutive patients (January 2001-December 2007) with computed tomography (CT)-scan-confirmed massive bilateral central or paracentral PE were reviewed. All clinical data were retrieved from our patients' registry and completed by the evaluation of the CT-scan-derived right ventricle/left ventricle ratio (RV/LV ratio). Follow-up focused on clinical outcome and QoL was obtained.Eighty patients were analysed including 28 SE (35%) and 52 TL (65%), of whom 11 (21%) required TS. Demographics and preoperative characteristics were similar between SE and TL. Analysis of the RV/LV ratio revealed a ratio of 1.66 for SE and 1.44 for TL. The early mortality rate was not significantly different between the two groups (SE: 3.6% versus TL: 13.5%), whereas early mortality was 27% in those patients treated initially with thrombolysis and subsequently requiring SE (TS-group). Severe bleeding complications were lower in the SE-group (3.6% versus 26.5% P = 0.013). Intracerebral bleeding rates and neurological events were not statistically different. After a mean follow-up of 63 +/- 21 months, the mortality rate was 17.9% in the SE-group and 23.1% in the TL-group.SE is an excellent treatment option in massive PE with comparable early mortality rates and significantly less bleeding complications than TL. Patients having surgery after inefficient thrombolysis have the worst early outcome. The RV/LV CT-scan ratio might serve as a predictor to differentiate patients, who could profit from direct surgical intervention than thrombolytic treatment attempts. Further studies are required to confirm these results.