同期手术治疗心脏病和非心脏疾病

doi:10.19723/j.issn.1671-167X.2021.02.016

摘要/Abstract

摘要：

目的: 探讨同期手术治疗心脏病和非心脏疾病的可能性和可行性。方法: 自1999年7月至2018年8月,北京大学第一医院心脏外科联合胸外科、普通外科、泌尿外科、妇产科对111例同时患有心脏病和非心脏疾病的患者同期行心脏手术和其他外科手术,其中男性83例(74.8%)、女性28例(25.2%),年龄41~84岁,平均(64.64±8.97)岁。心脏疾病的构成包括冠心病、心脏瓣膜病、心脏肿瘤、慢性缩窄性心包炎和先天性心脏病;非心脏疾病的构成包括肺部良恶性疾病、胸腺瘤和胸腺囊肿、乳腺癌、胸壁巨大血管瘤、消化道良恶性疾病、泌尿系恶性肿瘤和妇科疾病。观察手术的短期和长期效果。结果: 2例患者术后死亡,住院死亡率为1.8%,其中1例为急诊冠状动脉搭桥术+膀胱癌根治术后第153天因多器官功能衰竭死亡,另1例为心包剥脱术+肺癌手术后第10天因多器官功能衰竭死亡,其余109例患者康复出院。住院期间手术并发症共13例,发病率为11.7%,包括术后出血2例(1.8%),肺部感染及低氧血症3例 (2.7%),上消化道出血1 例(0.9%),切口感染3例(2.7%),膈下脓肿1例(0.9%),术后急性肾功能衰竭及血液滤过3例(2.7%)。109例出院患者中,108例完成随访,所有患者都存活6个月以上,21例患者在随访1~5年期间因肿瘤复发或转移死亡,无心脏源性死亡。随访期间心功能不全1例,行经皮冠状动脉介入治疗1例,术后抗凝过度导致脑出血1例,切口疝1例。结论: 同期手术治疗心脏病和非心脏良性或恶性疾病安全可行,短期和长期生存率均满意。

关键词: 心脏外科手术, 冠状动脉分流术, 非心脏外科手术, 肿瘤切除术, 同期手术

Abstract:

Objective: To investigate the possibility and feasibility of one-stage cardiac and non-cardiac surgery. Methods: From July 1999 to August 2018, one hundred and eleven patients suffering from cardiac and non-cardiac diseases were treated by one-stage cardiac and non-cardiac operation in Department of Cardiac Surgery and Thoracic Surgery, General Surgery, Urinary Surgery, and Gynecology, Peking University First Hospital. There were 83 males (74.8%) and 28 females (25.2%), aged 41 to 84 years [mean age: (64.64±8.97) years]. The components of the cardiac disease included coronary heart disease, valvular heart disease, cardiac tumors, chronic constrictive pericarditis and congenital heart disease. The components of the non-cardiac diseases included lung benign and malignant diseases, thymoma and thymic cyst, breast cancer, chest wall giant hemangioma, digestive tract benign and malignant diseases, urinary system carcinoma and gynecological diseases. Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 1.8%. One patient died of multiple organ failure on the 153th days after emergency coronary artery bypass grafting (CABG) combined with radical resection of bladder cancer. The other of pericardium stripping with lung cancer operation died of the multiple organ failure on the tenth day after surgery. The remaining 109 patients recovered and were discharged. There were 13 cases of complications during the days in hospital. The total operative morbidity was 11.7%: postoperative hemorrhage in 2 cases (1.8%), pulmonary infection and hypoxemia in 3 cases (2.7%), hemorrhage of upper digestive tract in 1 case (0.9%), incisional infection in 3 cases (2.7%), subphrenic abscess in 1 case (0.9%), and postoperative acute renal failure and hemofiltration in 3 case (2.7%). Of the 109 patients discharged, 108 patients were followed up. All the patients survived for 6 months, and 21 patients died due to tumor recurrence or metastasis within 1 to 5 years of follow-up, but no cardiogenic death. During the follow-up period, 1 patient developed cardiac dysfunction, 1 patient underwent percutaneous coronary intervention (PCI), 1 patient had cerebral hemorrhage due to excessive postoperative anticoagulation, and 1 patient suffered from incisional hernia. Conclusion: One-stage surgeries in patients suffering from both cardiac and non-cardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.

Key words: Cardiac surgical procedures, Coronary artery bypass, Non-cardiac surgical procedures, Tumor resection, One-stage operation

中图分类号:

R654.2

杨阳,肖锋,王进,宋波,李西慧,张师杰,何志嵩,张寰,尹玲. 同期手术治疗心脏病和非心脏疾病[J]. 北京大学学报（医学版）, 2021, 53(2): 327-331.

YANG Yang,XIAO Feng,WANG Jin,SONG Bo,LI Xi-hui,ZHANG Shi-jie,HE Zhi-song,ZHANG Huan,YIN Ling. One-stage surgery in patients with both cardiac and non-cardiac diseases[J]. Journal of Peking University (Health Sciences), 2021, 53(2): 327-331.

图/表 2

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表2

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Items	CAD	Heart valve disease	Cardiac tumor	Pericarditis	Total
Pulmonary disease	35	3	3 (1 with muscle bridge)	1	41
Esophagus carcinoma	3				3
Thymoma and mediastinal tumor	5(1 with MR)	3 (1 with CAD)			7
Chest wall giant hemangioma		1			1
Breast carcinoma	1	1			2
Urinary system cancer	27	6	2 (1 with CAD)		34
The abdominal digestive system disease	17				17
Gynecological disease	1	4	1		6
Total	89	18 (1 with CAD)	6 (2 with CAD)	1	111

Items	Pulmonary operation	Esophageal operation	Urinary operation	Digestive operation	Gynecological operation	Thymic and mediastinal operation	Chest wall operation	Total
CABG and complex operation	35	3	27	17	1	5	1	89
Valve replasty or replacement	3		6	0	4	2	2	17
Cardiac tumor resection	3 (1 with muscle bridge release)		2 (1 with CABG)	0	1	0	0	6
Percardial stripping	1		0	0	0	0	0	1
Total	41	3	34	17	6	7	3	111