Piehler J M, Trastek V F, Pairolero P C, Pluth J R, Danielson G K, Schaff H V, Orszulak T A, Puga F J
J Thorac Cardiovasc Surg. 1985 Nov;90(5):662-7.
From 1965 through 1983, 43 patients underwent concomitant cardiac and pulmonary procedures at our institution. Most patients presented with cardiac symptoms and were incidentally found to have a roentgenographically indeterminate lung nodule. The pulmonary diagnosis of 38 patients was unknown preoperatively, and nine of these had a malignant lesion. All 43 cardiac procedures necessitated extracorporeal circulation. Thirty-one patients had benign pulmonary disease, 10 had bronchogenic carcinoma, and two had metastatic carcinoma. Concomitant pulmonary procedures were performed via median sternotomy and included single wedge resections in 32 patients, lobectomy in seven, multiple wedge resections in three, and pneumonectomy in one. Most resections were performed either before or after institution of bypass, without systemic anticoagulation. Of the two operative deaths (4.6%), one was related to intraparenchymal pulmonary hemorrhage after multiple wedge resections during anticoagulation. Thus, pulmonary resections performed during anticoagulation may be associated with increased risk and probably should be avoided. The second death was cardiac in origin and not related to pulmonary resection. The remaining patients recovered uneventfully. Definitive correction of both cardiac and pulmonary disease can be performed at one operation via a single incision with safety and benefit to the carefully selected patient.
从1965年到1983年，我院有43例患者接受了心脏和肺部联合手术。大多数患者表现为心脏症状，偶然发现有X线检查不能确定的肺结节。38例患者术前肺部诊断不明，其中9例有恶性病变。所有43例心脏手术都需要体外循环。31例患者患有良性肺部疾病，10例患有支气管肺癌，2例患有转移性癌。肺部联合手术通过正中胸骨切开术进行，包括32例患者行单楔形切除术，7例行肺叶切除术，3例行多楔形切除术，1例行全肺切除术。大多数切除术在建立体外循环之前或之后进行，未进行全身抗凝。在2例手术死亡患者（4.6%）中，1例与抗凝期间多楔形切除术后肺实质内出血有关。因此，抗凝期间进行肺切除术可能会增加风险，可能应避免。第二例死亡源于心脏，与肺切除术无关。其余患者恢复顺利。对于经过精心挑选的患者，通过单一切口一次手术可以对心脏和肺部疾病进行确定性矫正，且安全有益。
