部分肾切除术后肺栓塞抗凝治疗1例及文献复习

Anticoagulant Therapy for Pulmonary Embolism Post-Partial Nephrectomy: A Case Report and Literature Review

摘要: 病史摘要：继发于部分肾切除术的肺栓塞是极少见的术后并发症，本病例报道一例61岁的女性患者，既往有下肢深静脉血栓病史，入院诊断“右肾占位10天”。症状体征：在“后腹腔镜右肾部分切除术”术后3天突发胸闷、气短、大汗、乏力，心前区略感疼痛，该患者围术期肺栓塞风险高危。诊断方法：CT肺动脉血管成像示双肺段及段以下层面肺动脉多发栓塞。双下肢血管超声示双侧小腿肌静脉内径增宽伴血栓形成(完全填充型)。治疗方法：予抗凝治疗。临床转归：这是1例术前存在下肢深静脉血栓，于部分肾切除术后出现了肺栓塞的病例，予抗凝治疗，患者预后良好。

Abstract: Case Summary: Pulmonary embolism secondary to partial nephrectomy is an extremely rare postoperative complication. This case report describes a 61-year-old female patient with a history of deep vein thrombosis (DVT) in the lower extremities, who was admitted with a diagnosis of “right renal mass for 10 days.” Symptoms and Signs: On the third day following “retroperitoneal laparoscopic partial nephrectomy of the right kidney,” the patient suddenly developed chest tightness, shortness of breath, profuse sweating, and fatigue, with slight pain in the precordial area. This patient was identified as high-risk for perioperative pulmonary embolism. Diagnostic Methods: CT pulmonary angiography revealed multiple emboli in the segmental and subsegmental branches of the pulmonary arteries in both lungs. Bilateral lower extremity vascular ultrasound indicated widened diameters of the calf muscle veins with complete thrombus formation. Treatment Methods: Anticoagulant therapy was administered. Clinical Outcome: This case involves a patient with pre-existing lower extremity deep vein thrombosis who developed a pulmonary embolism following partial nephrectomy. The patient was treated with anticoagulant therapy and had a favorable prognosis.