[Postoperative thromboembolism of pulmonary artery]

Pathologo-morphological and clinical records of 803 surgical patients have been analysed, in whom the thromboembolism of pulmonary artery (TEPA) was the only or the main cause of the death. Intravital diagnosis of TEPA was established in 32% of all the deceased. 87% of patients with evident symptoms of the embolism died during the first 2 hours, 52.3% died during 15-30 min. 67% of all TEPA were revealed in postoperative weak 1, 15%--in week 2, and 18%--on later terms (15-45 days). 82.6% of patients who died of TEPA underwent elective operations, and 17.4%--urgent operations. The indications were absolute in 67.3% of cases and relative--in 32.7%. 3/4 of all embolisms developed during the smooth p/o period, and 1/4--on the background of various complications. The rate of TEPA with lethal outcomes made up: 4.3% after the amputation of the lower limb for acute and chronic arterial circulatory disturbances, 2.4%--after transvesical adenomectomy of the prostate, 0.7% and 0.2%--after the operations on the biliary system and the stomach, respectively, and 0.14%--after appendectomy. 410 random purposeful autopsies detected that the sources of the TEPA in 99.3% of cases were thromboses in the system of inferior caval vein which developed silently in 88.3% of cases. In 90.9% of patients thrombus came from the deep veins of the shin, and in 9.1%--from iliac and femoral veins. The rate of postoperative TEPA as a cause of death, according to the autopsies data, has increased from 1.4% in 1972-1973 to 2.1% in 1990-1991. Up to 1997 the rate of this index decreased to 1.3%, the quantity of the autopsies (in operated patients--100%) being equal, and in conditions of increased surgical activity. The positive tendency in the dynamics of lethality of TEPA in conditions of a large industrial city, according to authors' view, is referred chiefly to implementation of drug prophylaxis of postoperative thrombosis of the deep veins of the lower extremities using mini-doses of heparine.