Ciriaco Paola, Carretta Angelo, Calori Giliola, Mazzone Patrizio, Zannini Piero
Department of Thoracic Surgery, Scientific Institute H. San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
Eur J Cardiothorac Surg. 2002 Jul;22(1):35-40. doi: 10.1016/s1010-7940(02)00209-9.
Patients with lung cancer may present concomitant coronary arterial disease. Feasibility of lung resection is dependent on the severity of the cardiac impairment since it can increase operative morbidity and mortality. The aim of this study was to analyze the results of lung resection in patients with coronary arterial disease in terms of operative complications and hospital stay.
Between January 1993 and March 2001, 50 patients with coronary arterial disease underwent lung resection for cancer at our department. Nineteen patients with a curable left-main or multiple-vessel disease first underwent surgical (six patients) or transluminal (13 patients) myocardial revascularization. Twenty-two of the 31 patients who did not require myocardial revascularization presented a medium-high cardiac risk. Univariate analysis determined the impact of coronary disease on operative complications and hospital stay.
Surgery consisted in 40 lobectomies, three pneumonectomies and seven wedge resections. The overall mortality and morbidity rates were 4% and 28%, respectively. Ten patients (22%) experienced postoperative cardiac complications such as arrhythmia and there was one intraoperative death, three suffered secretion retention and one patient died as a consequence of a stroke. Occurrence of postoperative complications was influenced by age (P=0.02) and the presence of medium-high cardiac risk (P=0.03). Hospital stay was longer for patients who did not have prior myocardial revascularization (11.7+/-4 vs. 8.1+/-3 days) and underwent more extensive pulmonary resection (10.6+/-5 vs. 7.4+/-2 days).
Lung resection in patients with coronary arterial disease is justified in selected cases. Previous myocardial revascularization and limited resections can decrease operative complications and hospital stay. Careful preoperative evaluation can identify patients who might benefit from myocardial revascularization prior to surgery.
肺癌患者可能合并冠状动脉疾病。肺切除术的可行性取决于心脏损害的严重程度，因为它会增加手术的发病率和死亡率。本研究的目的是从手术并发症和住院时间方面分析冠状动脉疾病患者肺切除术的结果。
1993年1月至2001年3月，50例冠状动脉疾病患者在我科接受了肺癌肺切除术。19例患有可治愈的左主干或多支血管疾病的患者首先接受了外科手术（6例）或经皮腔内（13例）心肌血运重建术。31例不需要心肌血运重建的患者中有22例具有中高心脏风险。单因素分析确定了冠状动脉疾病对手术并发症和住院时间的影响。
手术包括40例肺叶切除术、3例全肺切除术和7例楔形切除术。总体死亡率和发病率分别为4%和28%。10例患者（22%）出现术后心脏并发症，如心律失常，术中死亡1例，3例出现分泌物潴留，1例患者因中风死亡。术后并发症的发生受年龄（P=0.02）和中高心脏风险的影响（P=0.03）。未进行过心肌血运重建的患者住院时间更长（11.7±4天对8.1±3天），接受更广泛肺切除术的患者住院时间更长（10.6±5天对7.4±2天）。
在某些特定情况下，冠状动脉疾病患者进行肺切除术是合理的。先前的心肌血运重建和有限的切除术可以降低手术并发症和缩短住院时间。仔细的术前评估可以识别出术前可能从心肌血运重建中获益的患者。
