Rao V, Todd T R, Weisel R D, Komeda M, Cohen G, Ikonomidis J S, Christakis G T
Division of Thoracic Surgery, Toronto Hospital, University of Toronto, Ontario, Canada.
Ann Thorac Surg. 1996 Aug;62(2):342-6; discussion 346-7.
Concomitant lesions of the heart and lung are uncommon, but when present they pose a therapeutic challenge for thoracic surgeons. A combined procedure avoids the need for a second major thoracic procedure and may improve outcomes and provide economic benefit. However, cardiopulmonary bypass may adversely affect the natural history of pulmonary malignancies.
The clinical records of 30 patients were reviewed who underwent simultaneous lung resection and cardiac operations between January 1982 and July 1995. Follow-up was obtained on all 30 patients (mean follow-up, 22 months; range, 1 to 100 months).
Twenty-four patients underwent coronary artery bypass grafting in conjunction with pulmonary resection. Six patients underwent aortic (n = 4) or mitral (n = 2) valve replacement. The pulmonary resections consisted of pneumonectomy (n = 3), lobectomy (n = 14), wedge excision (n = 12), and tracheal resection (n = 1). Twenty-one patients had pathologic findings that confirmed adenocarcinoma (n = 10), squamous cell carcinoma (n = 5), small cell carcinoma (n = 2), or other malignancy (n = 4). Tumor stage of primary lung cancers was stage I, n = 12; stage II, n = 3; and stage IIIa, n = 2. Pathologic examination revealed benign disease in 9 patients. There were two operative deaths, one due to aspiration and one due to stroke. There were three late deaths, two cardiac and one of metastatic disease. Overall late survival was 85% +/- 7% and 73% +/- 16% at 1 and 5 years, respectively. Actuarial survival for patients with malignant disease was 64% at 5 years.
Simultaneous cardiac operation and lung resection was not associated with increased early or late morbidity or mortality. Cardiopulmonary bypass does not adversely affect survival in patients with malignant disease. Cardiac valve replacement can be performed safely in conjunction with pulmonary resection.
心肺合并病变并不常见，但一旦出现，会给胸外科医生带来治疗挑战。联合手术可避免再次进行大型胸科手术的需要，可能改善治疗效果并带来经济效益。然而，体外循环可能对肺恶性肿瘤的自然病程产生不利影响。
回顾了1982年1月至1995年7月期间30例行同期肺切除和心脏手术患者的临床记录。对所有30例患者进行了随访（平均随访22个月；范围1至100个月）。
24例患者在肺切除的同时进行了冠状动脉旁路移植术。6例患者进行了主动脉（n = 4）或二尖瓣（n = 2）置换术。肺切除术包括全肺切除术（n = 3）、肺叶切除术（n = 14）、楔形切除术（n = 12）和气管切除术（n = 1）。21例患者的病理检查证实为腺癌（n = 10）、鳞状细胞癌（n = 5）、小细胞癌（n = 2）或其他恶性肿瘤（n = 4）。原发性肺癌的肿瘤分期为I期，n = 12；II期，n = 3；IIIa期，n = 2。病理检查显示9例患者为良性疾病。有2例手术死亡，1例因误吸，1例因中风。有3例晚期死亡，2例死于心脏疾病，1例死于转移性疾病。总体晚期生存率在1年和5年时分别为85%±7%和73%±16%。恶性疾病患者的5年精算生存率为64%。
同期心脏手术和肺切除与早期或晚期发病率及死亡率的增加无关。体外循环对恶性疾病患者的生存没有不利影响。心脏瓣膜置换术可与肺切除术安全地联合进行。
