肺切除联合非体外循环冠状动脉旁路移植同期手术治疗经验

Outcomes of combined pulmonary resection and off-pump coronary artery bypass grafting for patients with lung tumor and concurrent coronary heart disease

目的分析22例行肺切除术同期联合非体外循环冠状动脉旁路移植术（OPCAB）的肺部肿瘤合并严重冠心病患者的病历资料，总结同期手术临床经验。方法2003年1月至2011年12月，北京安贞医院胸外科共完成同期手术22例，其中男20例，女2例，平均年龄（65±4）岁。临床肿瘤分期大部分为Ⅰ、Ⅱ期，冠状动脉病变程度以两支或三支血管狭窄为主，心肺功能基本正常。正中开胸后先行肺肿瘤活检，OPCAB后根据病理结果行肺局部切除或肺癌根治手术。结果所有患者安全完成同期肺切除及OPCAB，平均搭桥2．3根。搭桥后11例患者经正中切口完成同期手术（肺癌根治7例，局部切除4例），9例经后外侧切口完成肺癌手术，另2例经后外侧切口完成单支乳内动脉至左前降支搭桥及肺癌根治手术。围手术期无死亡病例及新发心肌梗死情况。平均住院时间（17±7）do平均手术时间（233±41）min。术后18例患者确诊为非小细胞肺癌，4例为良性肿瘤。术后常见并发症：心律失常、肺不张、肺部感染。随访自术后10个月至5年，4例患者因肿瘤复发死亡。结论同期肺切除术联合OPCAB治疗肺部肿瘤合并冠心病安全、有效。

Objective To analyze the outcomes of lung resection and off-pump coronary artery bypass grafting （OPCAB） synchronously for the patients with lung tumor and concurrent coronary heart disease. Methods Twenty-two patients with lung tumor and concurrent coronary heart disease underwent combined surgical interventions between January 2003 and December 2011. They included 20 males and 2 females with a mean age of （65 ± 4） years. The TNM stage of lung cancer was predominantly at stages Ⅰ and Ⅱ. A majority of them had two and three-vessel disease. The tests of cardiothoracic functions were normal. The biopsy of lung tumor was carried out initially through sternotomy approach. Then OPCAB was performed. Finally lung resection was carried out according to the pathological results of lung tumor. Results All patients survived. The average number of anastomosed coronary vessels was 2.3. After myocardial revascularization through a sternotomy approach, the procedures included lobectomy and partial lung resections through sternotomy only （ n = 11 ）, lobectomy through a lateral thoractomy approach （ n = 9 ） and lobectomy and bypass to left anterior descending （LAD） through left thoracotomy only （ n = 2）. Neither death nor new MI occurred during the perioperative period. The mean stay in-hospital was （17 ±7 ） days and mean ooperative duration （233 ± 41 ） min. The diagnoses were non-small cell lung cancer （n = 18 ） and benign tumor （n =4）. The most frequent complications were cardiac arrhythmias, atelectasis and pulmonary infections. All of them were followed up for 10 - 60 months. Within this period, 4 patients died from cancer recurrence. Conclusion The combined procedure of OPCABG grafting and pulmonary resection is a safe and effective treatment option for patients with lung cancer and concurrent coronary heart disease.