Ma Xu-chen, Ou Song-lei, Zhang Zhi-tai, Hu Yan-sheng, Song Fei-qiang
Department of Thoracic Surgery, Beijing Anzhen Hospital, Capital Medical University, China.
Zhonghua Yi Xue Za Zhi. 2012 Nov 27;92(44):3134-6.
To analyze the outcomes of lung resection and off-pump coronary artery bypass grafting (OPCAB) synchronously for the patients with lung tumor and concurrent coronary heart disease.
Twenty-two patients with lung tumor and concurrent coronary heart disease underwent combined surgical interventions between January 2003 and December 2011. They included 20 males and 2 females with a mean age of (65 ± 4) years. The TNM stage of lung cancer was predominantly at stages I and II. A majority of them had two and three-vessel disease. The tests of cardiothoracic functions were normal. The biopsy of lung tumor was carried out initially through sternotomy approach. Then OPCAB was performed. Finally lung resection was carried out according to the pathological results of lung tumor.
All patients survived. The average number of anastomosed coronary vessels was 2.3. After myocardial revascularization through a sternotomy approach, the procedures included lobectomy and partial lung resections through sternotomy only (n = 11), lobectomy through a lateral thoracotomy approach (n = 9) and lobectomy and bypass to left anterior descending (LAD) through left thoracotomy only (n = 2). Neither death nor new MI occurred during the perioperative period. The mean stay in-hospital was (17 ± 7) days and mean operative duration (233 ± 1) min. The diagnoses were non-small cell lung cancer (n = 18) and benign tumor (n = 4). The most frequent complications were cardiac arrhythmias, atelectasis and pulmonary infections. All of them were followed up for 10-60 months. Within this period, 4 patients died from cancer recurrence.
The combined procedure of OPCABG grafting and pulmonary resection is a safe and effective treatment option for patients with lung cancer and concurrent coronary heart disease.
分析肺肿瘤合并冠心病患者同期行肺切除与非体外循环冠状动脉旁路移植术（OPCAB）的疗效。
2003年1月至2011年12月，22例肺肿瘤合并冠心病患者接受了联合手术干预。其中男性20例，女性2例，平均年龄（65±4）岁。肺癌TNM分期主要为Ⅰ期和Ⅱ期。大多数患者有双支和三支血管病变。心胸功能检查正常。最初通过胸骨切开术进行肺肿瘤活检。然后行OPCAB。最后根据肺肿瘤的病理结果进行肺切除。
所有患者均存活。平均吻合冠状动脉血管数为2.3支。通过胸骨切开术进行心肌血运重建后，手术方式包括仅通过胸骨切开术行肺叶切除术和部分肺切除术（n=11）、通过侧胸壁切开术行肺叶切除术（n=9）以及仅通过左胸壁切开术行肺叶切除术并旁路至左前降支（LAD）（n=2）。围手术期未发生死亡和新发心肌梗死。平均住院时间为（17±7）天，平均手术时间为（233±1）分钟。诊断为非小细胞肺癌（n=18）和良性肿瘤（n=4）。最常见的并发症是心律失常、肺不张和肺部感染。所有患者均随访10 - 60个月。在此期间，4例患者死于癌症复发。
OPCABG移植与肺切除联合手术是肺癌合并冠心病患者安全有效的治疗选择。
