食管癌切除同期非体外循环下冠状动脉旁路移植5例临床分析并文献复习  

Simultaneous esophagectomy and off-pump coronary artery bypass grafting for esophageal cancer：a report of five cases with literature review

作　　者：王洪涛[1] 王国磊[1] 王文光[1] 陈宇航[1] 吴振江[1] 丁成智[1] 

机构地区：[1]河南省胸科医院胸部肿瘤科,郑州450008

出　　处：《中华胸心血管外科杂志》2017年第7期394-396,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨同期食管癌切除和非体外循环下冠状动脉旁路移植手术的可行性及安全性，并总结临床经验。方法 回顾性分析我院自2009年5月至2014年12月先后同期手术治疗的5例食管癌合并严重冠心病患者的临床资料、手术方式及手术效果，并对国内、外相关文献进行复习。结果 1例经胸骨正中联合左开胸两切口，4例经左开胸单一切口完成同期手术，其中2例患者行主动脉弓下器械吻合，1例行主动脉弓上器械吻合，2例行左侧颈部手工吻合。冠状动脉三支病变3例，双支病变1例，单支病变1例。围手术期无死亡病例。术后并发心律失常、吻合口瘘和肺部感染各1例。1例术后生存至今，4例死于肿瘤复发转移，中位生存时间20.6个月。结论 食管癌合并严重冠心病患者同期行食管癌切除联合非体外循环下冠状动脉旁路移植安全可行，对于早期食管癌患者可能获益更大。Objective To explore the possibility and safety of the simuhaneous esophagectomy and off-pump coronary ar- tery bypass grafting（OPCABG） in patients suffering from esophageal cancer combined with coronary artery and summarize the clinical experiences. Methods We retrospectively analyzed the clinical dates of 5 patients performed at the Henan province Chest Hospital from May 2009 to December 2014. The related literature was reviewed. Results All patients were performed the simuhaneous esophagectomy and OPCABG through the single left posterolateral thoracotomy 4ca.ses and through median ster- notomy and left thoracotomy 1 case. Instrument anastomosis under aortic arch 2 cases and above aortic arch 1 case , left neek anastomosis by hand 2 cases. Coronary artery three ressel disease 3cases, double-vessel 1 case, left main single vessel 1 case. There was no hospital death in this series. Postoperative complications included arrhythmia,anastomotic fistula and pneumonia. Only one patient was still alive, the other patients died of tumor recun＇ence or metastasis and median survival time was 20.6 months. Conclusion Simultaneous esophagectomy and OPCABG is a sate and feasible treatment modality in patients with se- vere CAD and esophageal cancer and it may be more beneficial for the patient with early esophageal cancer.

关 键 词：食管癌 冠心病 非体外循环冠状动脉旁路移植 同期手术 

分 类 号：R654.2[医药卫生—外科学] R735.1[医药卫生—临床医学]