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采用体外循环与泌尿外科肿瘤手术的联合手术——6例经验

Combined procedures using the extracorporeal circulation and urologic tumor operation--experiences in six cases.

作者信息

Litmathe J, Atmaca N, Menghesha D, Krian A

机构信息

Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University, Moorenstrasse 5, D-40225 Dusseldorf, Germany.

出版信息

Interact Cardiovasc Thorac Surg. 2004 Mar;3(1):132-5. doi: 10.1016/S1569-9293(03)00236-6.

Abstract

We investigated the question whether combined open heart surgery and urologic tumor operations may be helpful for patients with coincident diseases. From 8/1989 to 8/2000 six patients underwent combined open heart surgery and urologic tumor operation (61-76 years). Two patients suffered from aortic valve stenosis, four patients from ischemic heart disease. Concerning the kidney five patients had an adenocarcinoma, one patient a non-Hodgkin's lymphoma. In two patients we performed an aortic valve replacement and tumor nephrectomy (partial resection of the kidney), respectively. Four patients underwent myocardial revascularization and the corresponding tumor operation. The immediate postoperative course shows satisfactory results. In long-term follow-up one patient reported a low level of loading capacity, however, without typical ischemic symptoms. A clue for a tumor recidivism has not yet been observed. Two patients died 2.5 years after the operation, but the underlying reasons remain speculative because of missing autopsy. Patients suffering from both cardiovascular and kidney disease can be treated in only one setting with low risk. Remembering critically the limited number of cases, we conclude that combined procedures should take preference of operations in two settings, which is in agreement with the current data from the literature.

摘要

我们研究了心脏直视手术与泌尿外科肿瘤手术联合进行对患有合并症的患者是否有益的问题。从1989年8月至2000年8月,6例患者(61 - 76岁)接受了心脏直视手术与泌尿外科肿瘤手术联合治疗。2例患者患有主动脉瓣狭窄,4例患者患有缺血性心脏病。关于肾脏,5例患者患有腺癌,1例患者患有非霍奇金淋巴瘤。我们分别对2例患者进行了主动脉瓣置换术和肿瘤肾切除术(肾脏部分切除术)。4例患者接受了心肌血运重建术及相应的肿瘤手术。术后即刻病程显示出满意的结果。在长期随访中,1例患者报告负荷能力较低,但无典型缺血症状。尚未观察到肿瘤复发的迹象。2例患者在术后2.5年死亡,但由于未进行尸检,潜在原因仍属推测。患有心血管疾病和肾脏疾病的患者可在单一治疗中以低风险进行治疗。鉴于病例数量有限,我们得出结论,联合手术应优先于分两次进行手术,这与文献中的现有数据一致。

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