1例肺动脉取栓患者的多学科诊疗分析

doi:10.11958/20252012

天津医药 ›› 2025, Vol. 53 ›› Issue (12): 1320-1325.doi: 10.11958/20252012

1例肺动脉取栓患者的多学科诊疗分析

古博(), 谷松涛(), 李月川, 高淑连, 李崟, 杨立, 姜庆利

天津市胸科医院呼吸与危重症医学科（邮编300051）

收稿日期:2025-05-16 修回日期:2025-09-23 出版日期:2025-12-15 发布日期:2025-12-08
通讯作者: ^△E-mail：gusongtaodoctor@126.com
作者简介:古博（1984），男，副主任医师，主要从事慢性阻塞性肺疾病、肺癌、肺血管疾病的诊疗研究。E-mail：m13802057286@163.com
基金资助:
天津市医学重点学科建设项目(TJYXZDXK-3-032C)

Multi-disciplinary treatment analysis of a patient with pulmonary artery thrombectomy

GU Bo(), GU Songtao(), LI Yuechuan, GAO Shulian, LI Yin, YANG Li, JIANG Qingli

Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin 300051, China

Received:2025-05-16 Revised:2025-09-23 Published:2025-12-15 Online:2025-12-08
Contact: ^△E-mail：gusongtaodoctor@126.com

古博, 谷松涛, 李月川, 高淑连, 李崟, 杨立, 姜庆利. 1例肺动脉取栓患者的多学科诊疗分析[J]. 天津医药, 2025, 53(12): 1320-1325.

GU Bo, GU Songtao, LI Yuechuan, GAO Shulian, LI Yin, YANG Li, JIANG Qingli. Multi-disciplinary treatment analysis of a patient with pulmonary artery thrombectomy[J]. Tianjin Medical Journal, 2025, 53(12): 1320-1325.

摘要/Abstract

摘要：

肺动脉取栓是治疗急性肺栓塞（PE）的重要方法，其成功实施依赖于多学科团队的紧密协作。本文通过1例急性PE患者的诊疗过程，探讨肺动脉取栓的适应证、手术策略及多学科诊疗（MDT）的关键环节。该患者因喘憋就诊，经影像学确诊为肺栓塞，危险分层为中高危，在呼吸内科、心内科、心外科、影像科、超声科等多学科协作下，成功实施了经皮机械血栓清除术。术后患者血流再通、症状显著缓解，未发生严重并发症。该文为临床医生提供了肺动脉取栓MDT的参考框架，优化了肺栓塞患者的救治流程，为肺栓塞取栓治疗的病例选择和诊疗策略提供参考。

关键词: 肺栓塞, 肺动脉取栓, 经皮机械血栓清除术, 多学科诊疗

Abstract:

Pulmonary artery thrombectomy is an important method for treatment of acute pulmonary embolism (PE), and its successful implementation relies on the close collaboration of a multidisciplinary team. This article explores the indications, surgical strategies and key links of multidisciplinary treatment（MDT）for pulmonary artery thrombectomy through the diagnosis and treatment process of a patient with acute pulmonary embolism. The patient sought medical attention due to wheezing and was diagnosed with pulmonary embolism through imaging, with a risk stratification of medium to high risk. With the collaboration of multiple disciplines including respiratory medicine department, cardiology department, cardiac surgery department, radiology department and ultrasound department, percutaneous mechanical thrombectomy was successfully performed. After the surgery, the patient's blood flow was restored, symptoms were significantly relieved, and no serious complications occurred. This article aims to provide a reference framework for MDT in pulmonary artery thrombectomy for clinical doctors, optimize the treatment process for patients with pulmonary embolism, and provide reference for case selection and diagnosis and treatment strategies of thrombectomy treatment of pulmonary embolism.

Key words: pulmonary embolism, pulmonary artery thrombectomy, percutaneous mechanical thrombectomy, multi-disciplinary treatment

中图分类号:

R563.5

图/表 3

图1 患者的肺动脉CTA（PMT前） A：右肺动脉主干栓塞；B：双下肺动脉栓塞；白色箭头提示血栓。

Fig.1 Pulmonary CTA of the patient (before PMT)

图2 患者术中取出的血栓及病理染色 A：术中取出的血栓；B：红色血栓（马松染色，×100），可见多量变性红细胞及纤维蛋白，伴散在炎细胞浸润，免疫组化CD31（+），CD34（少许+），LCA（散在+），Vimentin（+），Ki-67（+<5%）；C：白色血栓（马松染色，×100），为混合性血栓，伴炎细胞浸润，免疫组化CD31（+），CD34（部分+），LCA（散在+），Vimentin（+），Ki-67（+<5%）。

Fig.2 Macroscopic and pathological views of the retrieved thrombus

图3 患者的肺动脉CTA（PMT 3个月后） A：右肺动脉主干；B双下肺动脉；白色箭头提示原肺动脉血栓已消失。

Fig.3 Pulmonary CTA of the patient（after 3 months of PMT)

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1例肺动脉取栓患者的多学科诊疗分析

Multi-disciplinary treatment analysis of a patient with pulmonary artery thrombectomy

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