冠脉支架植入术后短期内行开胸手术的可行性研究

目的探讨冠脉支架植入术后短期内行开胸手术的可行性。方法回顾冠脉支架植入术后3周内试行开胸手术患者16例，其中肺癌10例（A组）、食管癌6例（C组）。与未合并心脏疾病行开胸手术的30例肺癌患者（B组）、30例食管癌患者（D组）比较开胸术后的并发症及临床数据。结果16位患者CSI手术成功率为100％，狭窄程度由术前的80～100降至〈5％。A组的平均开胸手术时间，平均术中出血量、平均住院时间与B组对比差异无统计学意义（均P〉0．05）。A组的术后胸腔引流量、术后拔管时间均大于B组（均P〈0．01）。C组的平均开胸手术时间与D组对比差异无统计学意义（均P〉0．05），但C组平均术中出血量、平均住院时间、术后胸腔引流量及拔管时间均明显多于D组（均P〈0．01），且C组中有两例出现严重的并发症。结论在合理应用抗凝药物、做好围手术期准备工作的前提下，冠脉支架植入术后短期内行肺叶切除术是可行安全的，但行食管癌根治术还有待于进一步探讨。

Feasibility of thoracotomy shortly after coronary stent implantation

Objective To explore the feasibility of thoracotomy shortly after coronary stent implantation （CSI）. Methods Ten patients with lung cancer （Group A） and 6 patients with esophageal cancer （Group C）, totally 16 cases, underwent thoracotomy and resection of cancer who received CSI at most 3 weeks before. Thirty patients of lung cancer （Group B） and 30 patients of esophageal cancer （Group D）, totally 60, all without coronary heart diseases, underwent thoracotomy and resection of cancer （lobeetomy and resection of esophageal cancer）. The effects and complications of these groups were compared. Results The success rate of CSI of the 16 cases was 100%, and the stenosis rate of the vessels was reduced from 80% ~100 pre-operationally to less than 5% post-operatively. No significant differences in operation time, blood loss, and postoperative hospitalization time between Groups A and B （all P〉0.05）. The values of chest drainage amount and extubation time of Group A were higher than those of Group B （all P〈0.01）.There was no significant difference in operation time between Groups C and D （all P〉0.05）, however, the values of blood loss amount, postoperative hospitalization time, chest drainage amount, and extubation time of Group C were all significantly higher than those of Group D （all P〈O.01）,and two patients in Group C suffered from serious complications.Conclusion With reasonable antithrombotic measures and consummate perioperative preparations, lobectomy shortly after coronary stent implantation is feasible and safe, while esophageal cancer resection remains to be discussed onwards.