非小细胞肺癌外科治疗联合同期非体外循环冠状动脉旁路移植术

Simultaneous Surgical Treatment of Non-small Cell Lung Cancer and Off-pump Coronary Artery bypass Grafting

背景与目的外科治疗肺癌患者合并不稳定冠心病时术后死亡率和严重心血管并发症发生率较高,其治疗常给胸外科医生造成挑战。本文提出该类患者根治性肺切除术联合同期非体外循环冠状动脉旁路移植术的早期效果并总结临床经验。方法7例可外科切除的合并心律失常、不稳定性心绞痛或近期心肌梗死的非小细胞肺癌患者,实施根治性肺叶切除术联合同期非体外循环冠状动脉旁路移植术。6例患者术前均经冠状动脉造影证实不宜行冠状动脉成形术或支架植入术,1例支架植入后效果不佳。采用胸骨正中切口,非体外循环冠状动脉旁路移植术后行肺叶切除术+纵隔淋巴结清扫术。其中左上肺叶切除2例,右上肺叶切除1例,右上、中叶切除1例,胸腔镜辅助下左下肺叶切除1例,右下肺叶切除2例。结果本组无住院死亡,1例术后7个月因脑血管意外死亡,1例术后并发房颤。术后病理检查5例为鳞癌,2例为腺癌。全部患者随访2-59个月,术后均未再次出现心肌缺血症状,1例右肺上、中叶切除术后19个月出现局部复发。结论在选择患者情况下,采用经胸骨正中切口根治性肺切除联合同期非体外循环冠状动脉旁路移植术对肺癌合并不稳定冠心病患者而言是一种安全有效的外科治疗方法,可能减少术后并发症的发生率。

Background and objective Patients with resectable lung cancer and unstable coronary heart disease are at high risks of postoperative death or severe cardioovascular complications. They always pose a therapeutic challenge for thoracic surgeons. The aim of this study is to summarize clinical experience of radical lung resection for cancer with simultaneous off-pump coronary artery bypass grafting. Methods Seven patients who suffered from non small cell lung cancer concomitant arrhythmia, unstable angina and recent history of myocardial infarction had been carried out simultaneous radical lohectomy and off-pump coronary artery bypass grafting. Preoperative 6 patients had been confirmed to he misfit for either coronary arteriopLasty or stent implanting by performing the coronary angiography. One patient had undergone stenting before the lung cancer had been diagnosed. The procedure through median sternotomy performed offpump coronary artery bypass grafting preceded lobectomy and mediastinal lymphadenectomy. Left upper Lohectomy was performed in 2 patients, right upper lobectomy was performed in 1 patient, right upper and middle lobectomy was performed in one patient, video thoracoscopy assisted left lower lobectomy was performed in 1 patient, right lower lobectomy was performed in 2 patients. Results There was no death of patient in hospital, however, a patient died 7th month postoperativeLy because of cerebrovascular accident. Atrial fibrillation was observed postoperatively in 1 patient. Five patients were diagnosed as squamous cell lung cancer by pathology examination, and 2 patients were adenocarcinoma. Follow-up ranging from 2 months to 59 monthswas available for these patients postoperatively. None of the patients showed evidence of angina and myocardial infarction after surgery. In one patient, who underwent left superior Lobectomy, local recurrence was found at 19 months after surgery. Conclusion In selected patients, simultaneous radical lung resection and off-pump coronary artery bypass grafting is a safe and effective treatment when unstable coronary heart disease and lung cancer coexist. The therapeutic strategy maydecrease the incidence of postoperative complications.