Syncope Caused by Pulmonary Embolism after Lung Resection-A Case Report

肺切除手術後併發肺栓塞導致暈厥－病例報告

陳建光(Chien-Kuang Chen) ； 陳志毅(Chih-Yi Chen) ； 陳品儒(Pin-Ru Chen)

《胸腔醫學》 30卷2期 (2015/04) Pp. 86-91

摘要

肺切除後發生肺栓塞的案例在台灣非常少見。它死亡率很高。因為手術後的常見的症狀與肺栓塞的症狀相似，造成診斷上的困難。在此我們將介紹一名肺切除手術術後併發肺栓塞的病人，暈厥是她的第一個表現症狀。其D-dimer的血漿濃度上升。診斷上經由核醫灌流／通氣檢查與電腦斷層確認。在接受抗凝血治療與氧氣支持後，她逐漸康復，共住院治療19天。六個月後電腦斷層檢查追蹤，無任何肺栓塞情形。在此我們回顧文獻關於肺栓塞的相關資料，包括：危險因子、預防方法、診斷工具與治療方式。D-dimer似乎適合用來做為篩選的工具。雖然在華人中，肺切除手術術後併發肺栓塞的機會不大，但還是要將此診斷放在心中，並且小心的處理病人。

關鍵字

肺栓塞 ； 肺切除

並列摘要

Pulmonary embolism (PE) after lung resection is a rare occurrence in Taiwan. It is associated with a high mortality rate, but the diagnosis is difficult because the symptoms and signs can be confused with those commonly seen after lung resection. We report a patient who developed PE after lung resection. Syncope was the first presenting symptom. Coagulation screening showed elevated levels of D-dimer. Diagnosis of PE was confirmed by ventilation/perfusion (V/Q) scan and high-resolution computed tomography (HRCT). The patient recovered well with anticoagulant treatment and oxygen support, and was discharged after 19 days. HRCT scan at the 6-month follow-up revealed no filling defect in the pulmonary artery. We reviewed the literature on the risk factors, prophylaxis, treatment and diagnosis of PE. Reports showed that D-dimer seems to be useful in screening. Although the incidence of PE after surgery is lower in ethnic Chinese populations, we should keep this uncommon disease in mind and manage the patients carefully.

並列關鍵字

pulmonary embolism ； lung resection ； D-dimer