Pulmonary endarterectomy for chronic thromboembolic obstruction: recent surgical experience.
Pulmonary endarterectomy for chronic thromboembolic obstruction: recent surgical experience.
复制标题
肺动脉内膜切除术治疗慢性血栓栓塞性梗阻：近期手术经验。
作者：
Utley;R. Spragg;Long Wb rd;K. M. Moser
1977 年 7 月至 1981 年 6 月期间，对 10 名年龄在 20 岁至 67 岁之间的患者进行了肺血栓内膜切除术治疗慢性肺栓塞。各 5 名患者被分配到纽约心脏协会功能分级 III 和 IV 级。所有患者均有肺动脉高压和肺血管阻力增加。所有患者均出现从叶动脉开始并累及 50% 以上的连续动脉的阻塞。五名患者的肺动脉完全阻塞。所有患者双肺均患有阻塞性疾病。肺血栓内膜切除术是通过中央肺动脉切开术并使用深低温和停循环来进行的。循环停止采用一到四次，总计长达 60 分钟。没有观察到神经功能缺损。所有患者均出现肺部再灌注水肿。所有患者的肺动脉高压和肺血管阻力均得到改善。 1 名患者术后晚期因肺衰竭死亡。所有幸存者的肺功能均得到改善，其中七名患者的肺功能达到两种功能级别。一项的改进相当于三个功能类别，另一项的改进相当于一个功能类别。
Pulmonary thromboendarterectomy for chronic pulmonary emboli was performed on ten patients, ages 20 to 67 years, between July 1977 and June 1981. Five patients each were assigned to New York Heart Association functional classes III and IV. All patients had pulmonary hypertension and increased pulmonary vascular resistance. Obstruction beginning in the lobar arteries and involving more than 50% of the sequential arteries was present in all patients. Five patients had complete obstruction of a pulmonary artery. All patients had obstructive disease in both lungs. Pulmonary thromboendarterectomy was performed through central pulmonary arteriotomies and by use of deep hypothermia and circulatory arrest. Circulatory arrest was employed in one to four periods totaling up to 60 minutes. No neurologic deficit was observed. All patients developed reperfusion edema in the lungs. All patients had improvement in pulmonary hypertension and pulmonary vascular resistance. One patient died of lung failure in the late postoperative period. All survivors had improved lung function, with two functional classes in seven patients. Improvement in one equaled three functional classes and in one, by one functional class.