Tsunezuka Yoshio
Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Kyobu Geka. 2020 Sep;73(10):855-861.
Recent changes in the demographics of surgical candidates, in terms of age, have increased the number of patients with surgical risk factors. In patients with preoperative cardiac diseases such as myocardial ischemia, arrhythmia, or congestive heart failure, it is important to offer any necessary preoperative medical examinations and treatments because postoperative cardiac failure is more of a concern in patients with already abnormal cardiac physiology, undergoing significant lung resection. Thoracic surgeons should be challenged by another conundrum to accurately select the best candidates for surgical treatment. Usually perioperative management of antithrombotic therapy in patients who need general thoracic operations such as lung cancer surgery after coronary artery stent placement or valve replacement have made recommendations, and heparinization is needed for patients with atrial fibrillation for prevention of thrombo-embolism. It is sometimes used in clinical practice as bridging therapy during the period of discontinuation of antiplatelet therapy for patients with cardiac complications after several cardiac surgery. As points to be aware of regarding surgical operations, minimal invasive surgery probably should be performed if possible.
近期，手术候选患者在年龄方面的人口统计学变化增加了具有手术风险因素的患者数量。对于患有术前心脏疾病（如心肌缺血、心律失常或充血性心力衰竭）的患者，进行任何必要的术前医学检查和治疗非常重要，因为对于心脏生理已经异常且要接受重大肺切除术的患者，术后心力衰竭更令人担忧。胸外科医生还应面对另一个难题，即准确选择最佳手术治疗候选人。通常，对于需要进行一般胸科手术（如冠状动脉支架置入或瓣膜置换术后的肺癌手术）的患者，围手术期抗血栓治疗已有相关建议，房颤患者需要肝素化以预防血栓栓塞。在多次心脏手术后出现心脏并发症的患者停用抗血小板治疗期间，它有时在临床实践中用作桥接治疗。关于外科手术需要注意的一点是，如果可能的话，应尽可能进行微创手术。
