Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Pulmonary Embolectomy for Treatment of Pulmonary Embolism

폐색전증의 수술적 치료

  • 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)
  • 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)
  • Published : 2009.08.05
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Abstract

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.

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.

Keywords

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