Charokopos Nicholas, Antonitsis Polychronis, Spanos Constantine, Rouska Efthymia, Spanos Panagiotis
Department of Thoracic and Cardiovascular Surgery, AHEPA University Hospital, Aristotelian University of Thessaloniki, Thessaloniki, Greece.
Surg Today. 2007;37(8):638-41. doi: 10.1007/s00595-006-3438-8. Epub 2007 Jul 26.
Cholelithiasis may be present concomitantly with cardiac disease. We performed a retrospective study to verify the safety and efficacy of synchronous cholecystectomy and open heart surgery.
Between 1999 and 2004, we performed synchronous cholecystectomy and open heart surgery in nine patients (group A) and open heart surgery alone in 1248 patients (group B). Open heart surgery was performed with open cholecystectomy (OC) in seven (77.7%) patients and with laparoscopic cholecystectomy (LC) in two (22.2%) patients. One patient with unstable angina and acute cholecystitis underwent simultaneous procedures. The indications for open heart surgery were coronary artery disease in eight (88.8%) patients and severe aortic stenosis in one (11.2%) patient.
In group A, the mean number of bypass grafts performed was 2.5 +/- 0.5, the mean operative time was 348.4 min, and patients remained intubated for 25.7 +/- 6.7 h. The mean intensive care unit (ICU) stay was 4.1 +/- 1.6 days and the mean postoperative hospital stay was 19.2 +/- 5.7 days. There was a significant difference between the two groups in these two variables. No intra-abdominal complications or mediastinitis occurred in the immediate postoperative period in the setting of concomitant procedures and the mortality rate was zero.
Synchronous cholecystectomy and open heart surgery can be performed safely in selected patients.
胆结石可能与心脏病同时存在。我们进行了一项回顾性研究，以验证同期胆囊切除术和心脏直视手术的安全性和有效性。
1999年至2004年期间，我们对9例患者（A组）进行了同期胆囊切除术和心脏直视手术，对1248例患者（B组）仅进行了心脏直视手术。心脏直视手术联合开腹胆囊切除术（OC）的有7例（77.7%）患者，联合腹腔镜胆囊切除术（LC）的有2例（22.2%）患者。1例不稳定型心绞痛合并急性胆囊炎患者接受了同期手术。心脏直视手术的适应证为8例（88.8%）患者患有冠状动脉疾病，1例（11.2%）患者患有严重主动脉瓣狭窄。
A组患者平均搭桥血管数为2.5±0.5，平均手术时间为348.4分钟，患者术后机械通气时间为25.7±6.7小时。平均重症监护病房（ICU）住院时间为4.1±1.6天，平均术后住院时间为19.2±5.7天。这两个变量在两组之间存在显著差异。同期手术患者术后早期未发生腹腔内并发症或纵隔炎，死亡率为零。
在选定的患者中，同期胆囊切除术和心脏直视手术可以安全进行。
