Hagiwara Hiroaki, Yoshizumi T, Nakayama T, Abe T, Nakayama M, Ito T
Departmert of Cardiovascular Surgery, Japanese Red Cross Nagoya 1st Hospital, Nagoya, Japan.
Kyobu Geka. 2007 Jun;60(6):441-4.
We report a case of a 66-year-old man who developed gastric cancer 5 years after coronary artery bypass grafting using right gastroepiploic artery graft (RGEA). Some authors reported successful gastrectomy preserving a functional RGEA, but it carries the risk of injury of the graft or graft spasm. Preoperatively, catheter intervention for target vessels of RGEA (right coronary artery: RCA) was tried but failed. We performed re-do coronary artery bypass grafting (CABG) via right thoracotomy with right internal thoracic artery (RITA)-radial artery (RA) composite graft. The composite graft was drawn into the peritoneal cavity through the diaphragm, and anastomosed to the RGEA on the anterior plane of the liver. After that, partial gastrectomy was performed with resection of the RGEA and dissection of the #6 lymph nodes. We consider this method is safe to treat such cases.
我们报告一例66岁男性患者,其在使用右胃网膜动脉移植物(RGEA)进行冠状动脉旁路移植术后5年发生了胃癌。一些作者报道了保留功能RGEA的成功胃切除术,但存在移植物损伤或移植物痉挛的风险。术前尝试对RGEA的靶血管(右冠状动脉:RCA)进行导管介入治疗,但未成功。我们通过右胸切口采用右胸廓内动脉(RITA)-桡动脉(RA)复合移植物进行了再次冠状动脉旁路移植术(CABG)。将复合移植物通过膈肌拉入腹腔,并在肝脏前平面与RGEA吻合。之后,进行了部分胃切除术,切除RGEA并清扫第6组淋巴结。我们认为这种方法治疗此类病例是安全的。