胃肠道恶性肿瘤术后肺栓塞防治体会.pdfVIP

腹部外科 2010年第 23卷第 4期 FuBuWaiKe，Aug．2010，Vo1．23，No．4 胃肠道恶性肿瘤术后肺栓塞防治体会 王海波 王宗宝 代明营 时强 骆诤 李传智 【摘要】 目的 探讨 胃肠道恶性肿瘤术后肺栓塞的病因、诊断、治疗及预防。方法 回顾性分析 2001年6月至2010年 1月收治的35例 胃肠道恶性肿瘤术后肺栓塞的病例资料。结果 35例均行 I)_二聚体检查，阳性率为 100％；行螺旋CT肺动脉造影32例 ，30例异常。行持续吸氧、抗凝等治疗 后治愈出院24例；行呼吸机辅助呼吸、溶栓抗凝等治疗后好转出院6例，因呼吸衰竭死亡4例，好转 后因切 口严重感染脓毒症死亡 1例。结论 胃肠道恶性肿瘤及其手术治疗是肺栓塞的高危因素；D- 二聚体检查结合螺旋CT肺动脉造影有助于肺栓塞的快速诊断；溶栓、抗凝治疗能减轻肺血管阻塞， 是挽救 胃肠道恶性肿瘤术后肺栓塞病人的有效方法。 【关键词】 肺栓塞；胃肠肿瘤．夕h科手术 Preventionandtreatmentofpulmonaryembolism followingmajorsurgeryofgastrointestinalmalignant tumors WAJNGHai-bo，W NGZong-bao，D ．『Ming-ying，eta1．DepartmentofGeneralSurgery， AffiliatedHospitalofQingdaoUniversityMedicalCollege，Qingdao266003，China [Abstract] Objective Tostudytheetiology，diagnosis，treatmentandprecautionofpulmonary embolismfollowingmajorsurgeryofgastrointestina1malignanttumors．Methods Thirty-fivecasesof pulmonaryembolismfollowingmajorsurgeryofgastrointestinalmalignanttumorsadmittedtoourhos— pita1betweenJune2001andJanuary2010wereanalyzedretrospectively．Results D-dimerchecking wasperformedonthe35patients，andthepositiveratewas100 ．SpiralCT pulmonaryangiography wasperformedon32patientsandabnormalfindingswerefound in30cases．Twenty-fourpatientswere curedthroughthetreatmentofoxygentherapyand anticoagulati0n．Sixpatientsrecoveredthroughthe treatmentofassistedrespirationbyrespirator，thrombolysisandanticoagulatiorLFourpatientsdiedof respiratoryfailure，and1patientdiedofwoundinfectionandsepsis．Conclusion GastrointestinalCflDC— erandsurgicaltreatmentaretheriskfactorsofpulmonaryembolism．Theexaminationofpulmonary arteriographybyspiralcomputedtomographyincombinationwithD-dimerishelpfultOtherapiddiag— nosisofpulmonaryembolism．Itcanmitigatethepulmonaryvascularblockageanddegradethefatality bygivingpatientsthetreatmentofthrombolysisandanticoagu1atiorL [Keywords] Pulmonaryembolism；Gastrointestinalneoplasms；Surgicalprocedures，operative 肺栓塞(pulmonaryembolism，PE)是 以各种栓