中国普外基础与临床杂志

中国普外基础与临床杂志

乳腺癌改良根治术后并发急性肺血栓栓塞 1 例 MDT 讨论

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目的 总结 1 例乳腺癌根治术后并发急性肺血栓栓塞患者的诊治过程及经验。 方法 回顾性分析兰州大学第一医院于 2018 年 3 月收治的 1 例在术前进行 MDT 的乳腺癌患者的临床资料,对 MDT 讨论进行总结,并对该患者术后并发急性肺血栓栓塞的讨论结果加以总结。 结果 患者存在肥胖、高龄、高血压、恶性肿瘤、手术应激等下肢深静脉血栓形成的诸多高危因素,接受乳腺癌改良根治术。术程顺利,手术用时约 90 min,出血量约 30 mL,无神经及血管损伤。术后第 10 天突发急性肺血栓栓塞,导致心功能衰竭,最终因呼吸功能衰竭和心脏功能衰竭导致外周循环灌注不足休克而死亡。 结论 对具有诸多高危因素的乳腺癌术后可能会发生下肢深静脉血栓所致急性肺血栓栓塞的乳腺癌患者,外科医生在围手术期的管理中应给予高度重视。

Objective To summarize the treatment measures and experience for one patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer. Methods The discussion on MDT (multi-disciplinary team) of a breast cancer patient admitted to The First Hospital of Lanzhou University in March 2018 and the results of the discussion on acute pulmonary thromboembolism after operation were summarized. Results This patient had many high risk factors for deep venous thrombosis of the lower extremities, such as obesity, advanced age, hypertension, malignant tumor, and surgical stress. The operative time was about 90 min and the blood loss was 30 mL, without nerve and vascular injuries. Acute pulmonary thromboembolism occurred suddenly on 10 days after operation, which led to heart failure. Eventually, the patient died of the peripheral circulatory insufficiency caused by respiratory failure and heart failure. Conclusion Surgeons should pay great attention to the perioperative management of the patients with many high-risk factors, who may occur acute pulmonary thromboembolism caused by deep venous thrombosis of lower limbs after radical mastectomy.

关键词: 乳腺癌; 急性肺血栓栓塞; 乳腺癌根治术; MDT

Key words: breast cancer; acute pulmonary thromboembolism; radical mastectomy; MDT

引用本文: 张凯光, 关泉林, 赵永勋, 赵鹏. 乳腺癌改良根治术后并发急性肺血栓栓塞 1 例 MDT 讨论. 中国普外基础与临床杂志, 2018, 25(12): 1502-1506. doi: 10.7507/1007-9424.201809050 复制

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