Masywny zator tętnicy płucnej po resekcji miąższu płuca – negatywne doświadczenie z przeszłości
Objective: The purpose of this study was to analyse 16 patients, which are died after massive pulmonary embolism after lung resection and answer the question whether it was possible to prevents as wall to find out whether an early diagnosis and embolectomy was possible.
Material: In the period of 1984- 1994 a series of 2042 lung resection was carried out. Heparin prophylactic was not ordered. Total mortality rate was 4.5%. In 16 cases /0.8%/ a massive pulmonary artery embolism developed post-operatively that resulted in the death of the patients.
Results: The patients were 50-76 years of age, 63.5 years on average. Lung cancer was diagnosed in 13 cases metastastatic tumours of the lungs in 2 cases, Reynauld syndrom in 1 case. 13 patients (81,25%) suffered from other diseases, that increased the risk of pulmonary embolism. Right pneumonectomy was performed in 8 patients, lobectomy in 4 cases, explorative thoracotomy in 1, sternotomy in 2, videothoracoscopy in 1.Total blood loses intraoperatively and postoperatively was balanced by transfusions. There were 8 cases where blood loses were from 500 to1000ml, 2 cases from 1000ml to 2000ml, three cases from 2000 to 3000, and 3 cases where blood loses were over 3000ml. The clinical symptoms of pulmonary artery embolism: tachycardia and dyspnoea in 9 patients (it lasted from 9 hours to 7 days/, shock in 4 patients that lasted from 1 to 30 hours, and a sudden circulatory arrest in 3 cases. The Ht prior to the embolism development was from 40 to 45 % in 6 cases, and over 45% in 10 cases. Since 1995 we have been maintaining the post-operative prophylactic by using heparin. In the period of 1996-1998 a series of 1158 operations was performed with no massive pulmonary artery embolisms observed.
Conclusions: Prophylactic action by using heparin and intensive postoperative physiotherapy can decreased the risk of pulmonary embolism.
An early and reliable diagnosis of pulmonary embolism, confirmed by imaging proved difficult.
Adres: dr hab. Eugeniusz Jadczuk
Katedra i Klinika Chirurgii Klatki Piersiowej AMG
ul. Dębinki, 780-211 Gdańsk
tel. 058 349 24 31