食管癌合并冠心病经同一胸部切口同期外科治疗13例临床观察  

Clinical observation of 13 cases of esophageal cancer complicated with coronary artery disease through the single thoracic incision combined with surgical treatment at the same period

作　　者：崔东[1] 陈茂林 栾加强 宋静超[1] 史可峰 钱如林[1] Cui Dong;Chen Maolin;Luan Jiaqiang;Song Jingchao;Shi Kefeng;Qian Rulin(Department of Thoracic Surgery,Henan Chest Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省胸科医院胸外科,河南郑州450008

出　　处：《临床医学》2020年第6期10-12,共3页Clinical Medicine

摘　　要：目的对合并严重冠心病的食管癌患者经同一胸部切口同期行非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)联合食管癌切除术,探讨此方法的安全性及可行性。方法选取2008年1月至2016年12月于河南省胸科医院确诊合并冠心病的食管癌患者13例,经检查均无肿瘤远处转移,冠状动脉病变狭窄≥75%,经同一胸部切口同期行OPCABG联合食管癌切除术。全组患者均先行OPCABG,再行食管癌切除术。采用左前外侧切口,经第6肋间进胸,取左侧乳内动脉及大隐静脉作为桥血管。结果全组患者均顺利完成手术,无术中死亡,无二次开胸止血。1例于术后第4天死亡,死因为低心排出量综合征。另外1例术后出现低心排,应用主动脉内球囊反搏(IABP)治疗后纠正。1例颈部吻合术后出现食管胃吻合口瘘。1例患者术后2年出现心绞痛,其余术后均未出现心绞痛或心肌梗死。结论经同一左前外侧切口能够顺利安全地完成OPCABG联合食管癌切除术。Objective To evaluate the safety and feasibility of off-pump coronary artery bypass grafting(OPCABG)combined with esophagectomy for esophageal cancer patients with severe coronary heart disease through the single thoracic incision.Methods From January 2008 to December 2016,13 cases of esophageal cancer with coronary heart disease confirmed in Henan Chest Hospital were selected.All patients had no distant metastasis,and coronary artery stenosis was more than 75%.OPCABG and esophagectomy were performed simultaneously through a single thoracic incision.Through this anterolateral thoracic incision which in the sixth intercostal space,all patients were operated with OPCABG followed by esophagectomy the left internal mammary artery and the saphenous vein were taken as the bridge blood vessels.Results All operations were successfully completed.There was no intraoperative death and secondary thoracotomy hemostasis.One patient died on the 4th day after operation because of low cardiac output syndrome.Another patient developed low cardiac output after operation,which was corrected by intra-aortic balloon pump(IABP).One patient developed anastomotic leakage after esophagogastric cervical anastomosis.One patient developed angina pectoris 2 years after operation.The other patients had no angina pectoris or myocardial infarction after operation.Conclusions OPCABG combined with esophageal cancer resection can be successfully and safely performed through the single left thoracic anterolateral incision.

关 键 词：食管癌 非体外循环冠状动脉旁路移植术 食管切除术 

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