肺叶楔形切除术后并发急性缺血性卒中行介入取栓治疗2例并文献回顾 Interventional Thrombectomy in Patients with Acute Ischemic Stroke after Wedge Resection of Pulmonary Lobes: Two Case Reports and Literature Review

Abstract

肺叶楔形切除术后围手术期并发急性缺血性卒中的发生率虽然不高，但严重者可导致终身残疾甚至死亡，影响患者预后，其发病机制目前仍不明确。本文报道了2例肺癌手术后并发急性缺血性卒中经介入取栓治疗的病例，病例1行胸腔镜下左肺上叶楔形切除术后当天，左侧大脑中动脉急性栓塞导致左侧大脑半球大面积梗死，经介入取栓治疗血管再通[脑梗死溶栓分级（TICI 3级）后，患者预后良好（NIHSS评分4分）。病例2行胸腔镜下右下肺楔形切除术后当天，基底动脉闭塞导致小脑大面积梗死，经介入取栓治疗后血管再通良好（TICI 3级），但患者术后脑水肿严重，最终放弃治疗。本文通过总结诊疗经验并回顾相关文献，分析肺叶楔形切除术后并发急性缺血性卒中的可能机制，以供临床参考。 Abstract: The incidence of acute ischemic stroke during the perioperative period after wedge resection of pulmonary lobes is not high, but it may lead to life-long disability and even death in severe cases, thus affecting the prognosis of patients. At present, the pathogenesis is still unclear. This paper reported two cases of interventional thrombectomy in patients with acute ischemic stroke after lung cancer surgery. Patient 1 underwent wedge resection of the upper lobe of the left lung under thoracoscope. On the same day, acute embolism of the left middle cerebral artery caused extensive infarction in the left cerebral hemisphere. After interventional thrombectomy and recanalization (TICI grade 3), the patient had a good prognosis (NIHSS score of 4). Patient 2 underwent the right inferior pulmonary wedge resection under thoracoscope. On the same day, basilar artery occlusion caused extensive cerebellar infarction. After interventional thrombectomy, the blood vessels reopened well (TICI grade 3), but the patient had severe postoperative brain edema and ultimately gave up treatment. This paper summarized the experience, reviewed relevant literature and analyzed the high-risk factors for acute ischemic stroke after wedge resection of pulmonary lobes, to provide a reference for clinical practice.

Keywords

• 肺叶楔形切除术
• 急性缺血性卒中
• 介入取栓治疗
• wedge resection of pulmonary lobe
• acute ischemic stroke
• interventional thrombectomy treatment