Journal of Chest Surgery

  • 제42권4호
  • /
  • Pages.492-496
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  • 2009
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

폐색전증의 수술적 치료

Pulmonary Embolectomy for Treatment of Pulmonary Embolism

  • 박병준 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 박표원 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 심영목 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 박계현 (분당서울대학교병원 흉부외과) ;
  • 김진국 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 김욱성 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 성기익 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실)
  • Park, Byung-Joon (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Pyo-Won (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shim, Young-Mog (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Young-Tak (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Kay-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Kim, Jhin-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Wook-Sung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung, Ki-Ick (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2009.08.05
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초록

배경: 급성 폐색전증은 그 치료가 어려우며 대량의 색전증이 발생하여 심인성 쇼크를 동반할 경우 치명적인 결과를 초래할 수 있다. 과거 폐색전증 환자의 수술적 치료는 마지막 수단으로 여겨져 왔다. 하지만 저자들은 폐색전증 제거술을 시행한 7예의 경험을 토대로 치료 대안으로서 수술의 필요성을 검토하고자 하였다. 대상 및 방법: 8년간 본원에서 폐색전 제거술을 시행한 환자들의 의무 기록을 바탕으로 후향적 연구를 시행하였다. 입원 기간 및 마지막 외래 진료까지 경과 관찰하였다. 결과: 7명의 환자(남자 4명, 여자 3명)가운데 4명의 환자가 대량 폐색전증이었으며 나머지 3명은 아급성 폐색전증이었다. 3명의 환자는 수술 전 체외막산소공급장치를 삽입하고 수술을 받았다. 사망한 환자 없이 모두 퇴원하였으며 수술 후 시행한 심초음파 결과상 6명의 환자에서 폐동맥 고혈압 소견 없었다. 결론: 폐색전증 제거술은 대량의 폐색전증 환자에서 낮은 사망률로 시행할 수 있으며 저자들은 수술 전심인성 쇼크 상태인 환자에서 체외막산소공급장치가 생존율을 향상시킬 것으로 생각된다.

Background: The treatment of acute pulmonary embolism is difficult, and it can be lethal when cardiogenic shock is involved with major pulmonary embolism. In the past, pulmonary embolectomy was considered as the last choice for patients with pulmonary embolism. Accordingly, we analyzed our experience with seven cases of pulmonary embolectomy as an alternative option for the early treatment of pulmonary embolism. Material and Method: A retrospective analysis of medical charts of all patients who underwent pulmonary embolectomy at our hospital over the past eight years was performed. The patients were observed during their hospital stay and followed until their last visit to the outpatient department. Result: Among 7 patients (4 men and 3 women), 4 had massive pulmonary embolism, and 3 had sub massive pulmonary embolism. An extracorporeal membrane oxygenator was inserted in 3 patients before surgery. There was no mortality, and postoperative echocardiography showed no pulmonary hypertension in 6 patients. Conclusion: Pulmonary embolectomy can be performed with minimal mortality. We think that the use of an extracorporeal membrane oxygenator in patients with cardiogenic shock before surgery improves survival.

키워드

참고문헌

  1. Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation 2005;112:e28-32 https://doi.org/10.1161/CIRCULATIONAHA.105.551374
  2. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003; 163:1711-1717 https://doi.org/10.1001/archinte.163.14.1711
  3. Stein PD, Henry JW, Gottschalk A. Reassessment of pulmonary angiography for the diagnosis of pulmonary embolism: relation of interpreter agreement to the order of the involved pulmonary arterial branch. Radiology 1999;210:689-691 https://doi.org/10.1148/radiology.210.3.r99mr41689
  4. Schoepf UJ, Goldhaber SZ, Costello P. Spiral computed tomography for acute pulmonary embolism. Circulation 2004; 109:2160-2167 https://doi.org/10.1161/01.CIR.0000128813.04325.08
  5. Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006;354:2317-2327 https://doi.org/10.1056/NEJMoa052367
  6. Barritt DW, Jordan SC. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. Lancet 1960;1: 1309
  7. Levine MN, Raskob G, Beyth RJ, et al. Hemorrhagic complications of anticoagulant treatment: the seventh accp conference on antithrombotic and thrombolytic therapy. Chest 2004;126(3 Suppl):287S-310S https://doi.org/10.1378/chest.126.3_suppl.287S
  8. Thabut G, Thabut D, Myers RP, et al. Thrombolytic therapy of pulmonary embolism: a meta-analysis. J Am Coll Cardiol 2002;40:1660-1667 https://doi.org/10.1016/S0735-1097(02)02381-1
  9. Gulba DC, Schmid C, Borst HG, et al. Medical compared with surgical treatment for massive pulmonary embolism. Lancet 1994;343:576-577 https://doi.org/10.1016/S0140-6736(94)91523-7
  10. PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005;112:416-422 https://doi.org/10.1161/CIRCULATIONAHA.104.512834
  11. Schmitz-Rode T, Janssens U, Duda SH, Erley CM, Gunther RW. Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter. J Am Coll Cardiol 2000;36:375-380 https://doi.org/10.1016/S0735-1097(00)00734-8
  12. Tajima H, Murata S, Kumazaki T, et al. Hybrid treatment of acute massive pulmonary thromboembolism: mechanical fragmentation with a modified rotating pigtail catheter, local fibrinolytic therapy, and clot aspiration followed by systemic fibrinolytic therapy. AJR Am J Roentgenol 2004;183:589-595 https://doi.org/10.2214/ajr.183.3.1830589
  13. Ullmann M, Hemmer W, Hannekum A. The urgent pulmonary embolectomy: mechanical resuscitation in the operating theatre determines the outcome. Thorac Cardiovasc Surg 1999;47:5-8 https://doi.org/10.1055/s-2007-1013099
  14. Stulz P, Schlapfer R, Feer R, Habicht J, Gradel E. Decision making in the surgical treatment of massive pulmonary embolism. Eur J Cardiothorac Surg 1994;8:188-193 https://doi.org/10.1016/1010-7940(94)90113-9
  15. Yalamanchili K, Fleisher AG, Lehrman SG, et al. Open pulmonary embolectomy for treatment of major pulmonary embolism. Ann Thorac Surg 2004;77:819-823; discussion 823 https://doi.org/10.1016/j.athoracsur.2003.08.008
  16. Stein PD, Alnas M, Beemath A, Patel NR. Outcome of pulmonary embolectomy. Am J Cardiol 2007;99:421-423 https://doi.org/10.1016/j.amjcard.2006.08.050
  17. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):401S-428S https://doi.org/10.1378/chest.126.3_suppl.401S
  18. Clarke DB, Abrams LD. Pulmonary embolectomy: a 25 year experience. J Thorac Cardiovasc Surg 1986;92:442-445
  19. Maggio P, Hemmila M, Haft J, Bartlett R. Extracorporeal life support for massive pulmonary embolism. J Trauma 2007;62:570-576 https://doi.org/10.1097/TA.0b013e318031cd0c
  20. Kolvekar SK, Peek GJ, Sosnowski AW, et al. Extracorporeal membrane oxygenator for pulmonary embolism. Ann Thorac Surg 1997;64:883-884 https://doi.org/10.1016/S0003-4975(97)00502-X