Hirai K, Koizumi K, Ochi M, Yamada K, Kurita J, Hirata T, Yamagishi S, Kawashima T, Okada D, Enomoto Y, Nakajima Y, Shimizu K
Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan.
Kyobu Geka. 2005 Nov;58(12):1038-41.
Surgical strategy for patients for lung cancer with coronary disease remains controversial. We performed concomitant off-pump coronary artery bypass grafting (off-pump CABG: OPCAB) and left lower lobectomy with ND 2a lymph nodes dissection for lung cancer with pneumoconiosis. After CABG, due to fixed adhesion of peribronchial lymph node, left lower lobectomy was hard to carry out. Postoperative management was done with much difficulty for massive sputum and pneumonia caused by chronic inflammatory lung disease. As a result, postoperative course has been uneventful for 2 years after operation. In the concomitant OPCAB and lung resection with chronic inflammatory lung disease, whether the synchronous or 2 periods operation was appropriate was still unknown. We think that careful pre- and intraoperative assessment for this disease is important.
对于合并冠心病的肺癌患者,手术策略仍存在争议。我们为一名患有尘肺病的肺癌患者同期进行了非体外循环冠状动脉旁路移植术(非体外循环冠状动脉搭桥术:OPCAB)及左肺下叶切除术并清扫第2a组淋巴结。冠状动脉搭桥术后,由于支气管周围淋巴结粘连固定,左肺下叶切除术难以实施。术后因慢性炎症性肺病导致大量痰液和肺炎,术后管理困难重重。结果,术后2年病情平稳。对于同期行OPCAB及慢性炎症性肺病肺切除术,一期手术还是二期手术更为合适仍不明确。我们认为对此类疾病进行仔细的术前和术中评估很重要。