胃肠道恶性肿瘤术后肺栓塞防治体会

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1、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

2、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PreventionandtreatmentofpulmonaryembolismfollowingmajorsurgeryofgastrointestinalmalignanttumorsWAJNGHai-bo，WNGZong-bao，D．『Ming-ying，eta1．

3、DepartmentofGeneralSurgery，AffiliatedHospitalofQingdaoUniversityMedicalCollege，Qingdao266003，China[Abstract]ObjectiveTostudytheetiology，diagnosis，treatmentandprecautionofpulmonaryembolismfollowingmajorsurgeryofgastrointestina1malignanttumors．MethodsThirty-fiveca

4、sesofpulmonaryembolismfollowingmajorsurgeryofgastrointestinalmalignanttumorsadmittedtoourhos—pita1betweenJune2001andJanuary2010wereanalyzedretrospectively．ResultsD-dimercheckingwasperformedonthe35patients，andthepositiveratewas100．SpiralCTpulmonaryangiographywasp

5、erformedon32patientsandabnormalfindingswerefoundin30cases．Twenty-fourpatientswerecuredthroughthetreatmentofoxygentherapyandanticoagulati0n．Sixpatientsrecoveredthroughthetreatmentofassistedrespirationbyrespirator，thrombolysisandanticoagulatiorLFourpatientsdiedofr

6、espiratoryfailure，and1patientdiedofwoundinfectionandsepsis．ConclusionGastrointestinalCflDC—erandsurgicaltreatmentaretheriskfactorsofpulmonaryembolism．TheexaminationofpulmonaryarteriographybyspiralcomputedtomographyincombinationwithD-dimerishelpfultOtherapiddiag—

7、nosisofpulmonaryembolism．Itcanmitigatethepulmonaryvascularblockageanddegradethefatalitybygivingpatientsthetreatmentofthrombolysisandanticoagu1atiorL[Keywords]Pulmonaryembolism；Gastrointestinalneoplasms；Surgicalprocedures，operative肺栓塞(pulmonaryembolism，PE)是以各种栓瘤1

8、例。并存有高血压者12例，糖尿病者10例，冠子栓塞肺动脉系统为其发病原因的一组疾病或临床心病者16例，脑梗死病史4例，慢性支气管炎3例。综合征的总称，其病死率为20430，是胃肠道所行术式分别为：Miles术3例，Dixon术9例，腹腔恶性肿瘤术后严重并发症之一。近年来，手术后肺镜下Dixon术3例，Harttman术1例，右半结