不停跳冠状动脉旁路移植术联合同期肺切除术

目的总结不停跳冠状动脉旁路移植术联合同期肺切除术的经验。方法7例不稳定性心绞痛或心肌梗死合并可切除肺部病变患者,实施不停跳冠状动脉旁路移植术联合同期肺切除术。所有患者术前行冠状动脉造影证实不宜行冠状动脉成形术或支架植入术。采用胸骨正中切口,不停跳冠状动脉旁路移植术后行肺切除术。左上肺叶切除2例,右上肺叶切除1例,右上、中叶切除1例,右下肺叶切除1例,左侧肺减容术1例,双侧肺减容术1例。结果本组无住院死亡,但有1例后期死亡。术后并发症包括1例胸骨哆开再次开胸固定、1例房颤。病理检查结果5例肺部恶性肿瘤、2例慢性阻塞性肺气肿。患者随访2～31个月,所有患者术后没有再次出现心肌缺血症状,1例行右肺上、中叶切除患者术后19个月出现局部复发。结论胸骨正中切口不停跳冠状动脉旁路移植术联合同期肺切除术是安全有效的并能降低术后并发症。

Simultaneous off-pump coronary artery bypass surgery and pulmonary resection

Objective To summarize the experience of combined off-pump coronary artery bypass grafting(OPCAB)and pulmonary resection.Methods Seven patients with unstable angina or a history of myocardial infarction and pulmonary disease underwent combined OPCAB and pulmonary resection.All of them underwent coronary angiography,and neither coronary angioplasty nor stenting was feasible.OPCAB preceded the lung resections.The preferred approach to the heart and lung was by sternotomy.Left upper lobectomy was performed in 2 patients,right upper lobectomy was performed in 1 patient,right lower lobectomy was performed in 1 patient,right upper and middle bilobectomy was performed in 1 patient,left lung volume reduction surgery(LVRS)was performed in 1 patient and bilateral LVRS was performed in 1 patient.Results There were no hospital mortality in this group of patients,however there were one late death.Sternal dehiscence occurred in 1 patient which was observed with a need for resternotomy and atrial fibrillation was observed in 1 patient.Five patients were diagnosed as malignant tumor by pathology test,and 2 patients were severe chronic obstructive pulmonary disease(COPD).Follow-up ranging from 2 months to 31 months was available for these patients.None of the patients showed evidence of myocardial ischemia after surgery.In one patient,who underwent right upper and middle bilobectomy,local recurrence was found at 19 months after surgery.Conclusions OPCAB carried out simultaneously with lung resection is a safe and effective approach in patients diagnosed with concomitant coronary artery and pulmonary disease.OPCAB may decrease the incidence of postoperative complications.