Risk factor analysis of cerebral infarction and clinicopathological characteristics of left upper pulmonary vein stump thrombus after lobectomy
Risk factor analysis of cerebral infarction and clinicopathological characteristics of left upper pulmonary vein stump thrombus after lobectomy
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DOI：
10.1007/s11748-018-1017-8
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发表时间：
2019-02-01
影响因子：
1.2
通讯作者：
Suzuki, Kenji
中科院分区：
文献类型：
--
作者：
Hattori, Aritoshi;Takamochi, Kazuya;Suzuki, Kenji
目的分析肺叶切除术后左上肺静脉残端脑梗死（CI）和血栓形成的危险因素。方法回顾性调查1670例肺叶切除术及以上介入治疗患者，分析术后CI的危险因素。此外，对接受左上叶切除术（LUL）的患者的术后对比增强计算机断层扫描（CE-CT）进行了审查，并对左上肺静脉残端血栓形成的风险因素进行了评价。结果脑梗死发生率为0. 60%（10/10），左侧病变发生率为90%（10/10），左侧病变发生率为50%（10/10）。80%的CI病例发生在术后第4天。LUL后CI发生率为1.47%。在339例接受LUL的患者中，137例（40%）在术后进行了CE-CT检查。其中，左上肺静脉残端血栓16例（11.7%），这在较高年龄和II期或以上疾病中具有统计学显著性（=0.003，0.040）。与此相反，术前的历史，包括抗凝剂管理，房颤，糖尿病，几个外科手术或术中因素没有统计学上与血栓形成conclusionPostoperative CI发生在非常早期的阶段后肺叶切除术，和发病率显着较高的患者进行LUL。由于左上肺静脉残端血栓经常被回顾性发现，因此需要进行一项前瞻性观察研究，以调查肺叶切除术后肺静脉残端血栓的真实的发生率。
ObjectiveWe aimed to analyze the risk factors of postoperative cerebral infarction (CI) and thrombus formation in the left upper pulmonary vein (PV) stump after lobectomy.MethodsWe retrospectively investigated 1670 patients who underwent lobectomy or more intervention, and analyzed the risk factors of postoperative CI. Furthermore, postoperative contrast-enhanced computed tomography (CE-CT) were reviewed in patients who underwent left upper lobectomy (LUL), and risk factors of the thrombus formation in the left upper PV stump were evaluated. Chi-square test or unpaired t test was used to compare the factors.ResultsCerebral infarction was observed in 10 (0.60%) patients, being more significant in patients with left side lesions (90%) who underwent LUL (50%). Eighty percent of the CI cases occurred by day 4 postoperative. CI was found in 1.47% after LUL. Among 339 patients who underwent LUL, CE-CT was performed in 137 (40%) postoperatively. Among them, left upper PV stump thrombus was found in 16 (11.7%), which was statistically significant in higher age and p stage II or more disease (=0.003, 0.040). In contrast, preoperative histories including anticoagulant administration, atrial fibrillation, diabetes mellitus, several surgical procedures or intraoperative factors were not associated statistically with thrombus formation.ConclusionPostoperative CI occurred in the very early-phase after lobectomy, and the incidence was significantly higher in patients undergoing LUL. Because left upper PV stump thrombus was frequently found retrospectively, a prospective observation study would be required to investigate the real incidence of PV stump thrombus after lobectomy.