Okamoto T, Okubo K, Miyamoto N, Kurahashi Y, Isobe J, Ueno Y, Katoh T
Department of Thoracic Surgery, National Gifu Hospital, Gifu, Japan.
Kyobu Geka. 2002 Nov;55(12):1014-7.
A 71-year-old man was admitted because of an abnormal shadow on the chest X-ray film. Chest computed tomography (CT) revealed a tumor in the right upper lobe. The diagnosis of lung cancer was made by transbronchial lung biopsy. He had suffered an infarction of the inferior myocardial wall at the age of 55 years. Preoperative coronary angiography revealed total occlusion of segment 1, 75% stenosis of segments 5 and 6, and 90% stenosis of segment 13. Since these coronary lesions could cause perioperative and postoperative myocardial infarction, the patient was scheduled to undergo surgery of both the heart and lung in a one-stage operation. Under intraaortic balloon pumping (IABP), we performed a right upper lobectomy of the lung, and coronary artery bypass grafting with cardiopulmonary bypass through median sternotomy. During the lobectomy and first postoperative day, a stable circulation was achieved with IABP. The postoperative course was uneventful. At present, that is 33 months after the operation, the patient presents no sighs of recurrence of lung cancer and has not suffered any anginal attack during follow-up. Lung cancer and coronary artery disease can be treated simultaneously by this procedure.
一名71岁男性因胸部X光片出现异常阴影入院。胸部计算机断层扫描（CT）显示右上叶有肿瘤。经支气管肺活检确诊为肺癌。他55岁时曾发生下壁心肌梗死。术前冠状动脉造影显示1段完全闭塞，5段和6段75%狭窄，13段90%狭窄。由于这些冠状动脉病变可能导致围手术期和术后心肌梗死，该患者计划在一期手术中同时进行心脏和肺部手术。在主动脉内球囊反搏（IABP）支持下，我们通过正中胸骨切开术，在体外循环下行冠状动脉搭桥术并同期行右肺上叶切除术。在肺叶切除术中及术后第一天，IABP维持了循环稳定。术后恢复顺利。目前，术后33个月，患者无肺癌复发迹象，随访期间未发生心绞痛发作。通过该手术可同时治疗肺癌和冠状动脉疾病。
