Yang Y, Xiao F, Wang J, Song B, Li X H, Zhang S J, He Z S, Zhang H, Yin L
Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China.
Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Mar 30;53(2):327-331. doi: 10.19723/j.issn.1671-167X.2021.02.016.
To investigate the possibility and feasibility of one-stage cardiac and non-cardiac surgery.
From July 1999 to August 2018, one hundred and eleven patients suffering from cardiac and non-cardiac diseases were treated by one-stage cardiac and non-cardiac operation in Department of Cardiac Surgery and Thoracic Surgery, General Surgery, Urinary Surgery, and Gynecology, Peking University First Hospital. There were 83 males (74.8%) and 28 females (25.2%), aged 41 to 84 years [mean age: (64.64±8.97) years]. The components of the cardiac disease included coronary heart disease, valvular heart disease, cardiac tumors, chronic constrictive pericarditis and congenital heart disease. The components of the non-cardiac diseases included lung benign and malignant diseases, thymoma and thymic cyst, breast cancer, chest wall giant hemangioma, digestive tract benign and malignant diseases, urinary system carcinoma and gynecological diseases.
Two patients died after operations in hospital; thus, the hospital mortality rate was 1.8%. One patient died of multiple organ failure on the 153th days after emergency coronary artery bypass grafting (CABG) combined with radical resection of bladder cancer. The other of pericardium stripping with lung cancer operation died of the multiple organ failure on the tenth day after surgery. The remaining 109 patients recovered and were discharged. There were 13 cases of complications during the days in hospital. The total operative morbidity was 11.7%: postoperative hemorrhage in 2 cases (1.8%), pulmonary infection and hypoxemia in 3 cases (2.7%), hemorrhage of upper digestive tract in 1 case (0.9%), incisional infection in 3 cases (2.7%), subphrenic abscess in 1 case (0.9%), and postoperative acute renal failure and hemofiltration in 3 case (2.7%). Of the 109 patients discharged, 108 patients were followed up. All the patients survived for 6 months, and 21 patients died due to tumor recurrence or metastasis within 1 to 5 years of follow-up, but no cardiogenic death. During the follow-up period, 1 patient developed cardiac dysfunction, 1 patient underwent percutaneous coronary intervention (PCI), 1 patient had cerebral hemorrhage due to excessive postoperative anticoagulation, and 1 patient suffered from incisional hernia.
One-stage surgeries in patients suffering from both cardiac and non-cardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.
探讨同期进行心脏及非心脏手术的可能性与可行性。
1999年7月至2018年8月，北京大学第一医院心脏外科、胸外科、普通外科、泌尿外科及妇科对111例患有心脏及非心脏疾病的患者进行了同期心脏及非心脏手术。其中男性83例（74.8%），女性28例（25.2%），年龄41至84岁[平均年龄：(64.64±8.97)岁]。心脏疾病包括冠心病、心脏瓣膜病、心脏肿瘤、慢性缩窄性心包炎及先天性心脏病。非心脏疾病包括肺部良恶性疾病、胸腺瘤及胸腺囊肿、乳腺癌、胸壁巨大血管瘤、消化道良恶性疾病、泌尿系统肿瘤及妇科疾病。
2例患者术后死于医院；因此，医院死亡率为1.8%。1例患者在急诊冠状动脉旁路移植术（CABG）联合膀胱癌根治术后第153天死于多器官功能衰竭。另1例肺癌手术心包剥脱术后第10天死于多器官功能衰竭。其余109例患者康复出院。住院期间有13例发生并发症。总手术并发症发生率为11.7%：术后出血2例（1.8%），肺部感染及低氧血症3例（2.7%），上消化道出血1例（0.9%），切口感染3例（2.7%），膈下脓肿1例（0.9%），术后急性肾衰竭及血液滤过3例（2.7%）。在109例出院患者中，108例进行了随访。所有患者均存活6个月，21例患者在随访1至5年内因肿瘤复发或转移死亡，但无心源性死亡。随访期间，1例患者出现心脏功能障碍，1例患者接受经皮冠状动脉介入治疗（PCI），1例患者因术后抗凝过度发生脑出血，1例患者发生切口疝。
对于患有心脏及非心脏良性或恶性疾病的患者，同期手术是安全可行的，短期和长期生存率均令人满意。
