Objective To investigate the safety of combined radical resection of lung cancer and off-pump coronary artery bypass surgery.Methods Patients undergoing combined radical resection of lung cancer and off-pump coronary artery bypass surgery (combined surgery group),lung resection (lung resection group) and off-pump coronary artery bypass grafting (coronary artery bypass grafting group) from January 2013 to December 2014 were enrolled,15 cases in each group.The duration of operation,duration of mechanical ventilation,postoperative drainage volume were recorded;the respiratory index (RⅠ),the levels of cardiac troponin Ⅰ (cTnⅠ) and creatine kinase-MB (CK-MB) were assessed 12,24,48,72 h and 7 d after operation.Results The duration of operation in combined surgery group was significantly longer than that in lung resection group and coronary artery bypass grafting group [(388 ± 110) min vs (227 ± 63),(188 ± 24) min] (P ＜ 0.01);the duration of mechanical ventilation was significantly longer,the postoperative drainage volume was significantly greater in in combined surgery group than those in lung resection group [(984 ± 194) min vs (442 ±267) min,(3 209 ± 1 823) ml vs (1 546 ±697) ml] (P ＜ 0.05,P ＜ 0.01).The RⅠ at all time points showed no significant differences among groups (P ＞ 0.05);the levels of cTnⅠ and CK-MB at different time points after operation in combined surgery group were significantly lower than those in lung resection group [12 h:1.27 (0.56,11.71) μg/L vs 0.03 (0.01,0.11) μg/L,15.60 (5.80,46.60) μg/L vs 7.10 (5.40,9.90) μg/L;24 h:0.68 (0.26,7.77) μg/Lvs0.02 (0.01,0.05) μg/L,11.90 (5.20,18.60) μg/Lvs4.80 (3.90,5.90) μg/L;48 h:0.64(0.09,4.43) μg/L vs 0.01 (0.00,0.02) μg/L,2.30 (1.90,4.20) μg/L vs 1.80 (1.30,2.71) μg/L;72 h:0.44 (0.04,1.73) μg/L vs 0.01 (0.00,0.02) μg/L,2.10 (1.70,2.40) μg/L vs 1.10 (0.80,1.80) μg/L;7 d:0.08 (0.01,0.24) μg/L vs 0.00 (0.00,0.01) μg/L,1.50 (0.90,2.20) μg/L vs 0.90 (0.70,1.40) μg/L] (P ＜ 0.05,P ＜ 0.01),while not significantly different from those in coronary artery bypass grafting group (P ＞ 0.05).Conclusion Combined radical resection of lung cancer and off-pump coronary artery bypass surgery not only improves myocardial blood flow and safety of lung cancer operation,but also ensures the timeliness of lung resection,and does not have adverse effect on cardiorespiratory function.%目的 探讨同期行肺癌根治联合不停跳冠状动脉旁路移植术的安全性.方法 纳入2013年1月至2014年12月首都医科大学附属北京安贞医院同期行肺癌根治联合不停跳冠状动脉旁路移植术(同期心肺手术组),行单纯肺癌根治术(单纯肺癌根治术组)和行单纯不停跳冠状动脉旁路移植术(单纯冠状动脉旁路移植术组)患者各15例.记录并比较各组手术时间、呼吸机辅助时间、术后引流量,术后12、24、48和72 h及术后7 d呼吸指数、心肌肌钙蛋白Ⅰ(cTnⅠ)以及肌酸激酶同工酶(CK-MB)水平.结果 同期心肺手术组手术时间明显长于单纯肺癌根治术组和单纯冠状动脉旁路移植术组[(388±110) min比(227±63)、(188 ±24) min] (P＜0.01),呼吸机辅助时间明显长于、术后引流量明显多于单纯肺癌根治术组[(984±194) min比(442±267) min,(3 209±l 823)ml比(1 546±697) ml] (P＜0.05、P＜0.01).3组患者术后呼吸指数、cTnⅠ和CK-MB指标均呈下降趋势;3组患者术后不同时点呼吸指数差异均无统计学意义(均P>0.05);同期心肺手术组各时点cTnⅠ和CK-MB明显高于单纯肺癌根治术组,差异有统计学意义[术后12h:1.27 (0.56,11.71) μg/L比0.03 (0.01,0.11)μg/L,15.60 (5.80,46.60) μg/L比7.10 (5.40,9.90) μg/L;术后24 h:0.68 (0.26,7.77) μg/L比0.02 (0.01,0.05) μg/L,11.90 (5.20,18.60) μg/L比4.80 (3.90,5.90) μg/L;术后48 h:0.64 (0.09,4.43) μg/L比0.01 (0.00,0.02) μg/L,2.30 (1.90,4.20) μg/L比1.80 (1.30,2.71) μg/L;术后72 h:0.44 (0.04,1.73)μg/L比0.01 (0.00,0.02) μg/L,2.10 (1.70,2.40) μμg/L比1.10 (0.80,1.80) μg/L;术后7 d:0.08 (0.01,0.24) μg/L比0.00 (0.00,0.01) μg/L,1.50 (0.90,2.20) μg/L比0.90 (0.70,1.40)μg/L](P＜0.05或P＜0.01),与单纯冠状动脉旁路移植术组比较差异无统计学意义(P>0.05).结论 同期行肺癌根治术联合不停跳冠状动脉旁路移植术,既改善了心肌缺血情况、保障了肺癌手术的安全性,又保证了肺癌外科治疗的及时性,对心肺功能无不良影响,安全性较好.
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