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目的:探讨经左后外侧切口行非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)同期行食管癌根治术的安全性、可行性及疗效。方法:13例冠心病合并可切除食管癌病变患者,经左后外侧切口同期行OPCABG联合食管癌根治术。总结术中操作及围手术期管理要点。结果:本组患者手术顺利,无重大并发症,无手术死亡;其中1例术后30 d严重感染院内死亡。2例术后再次气管插管,经积极治疗后顺利出院。术后并发症包括房颤、肺不张、肺部感染。平均手术时间(424.07±91.68)min,术中失血(569.23±343.10)m L,术后住院时间(20.00±7.21)d。术后随访4~40个月,1例术后第37个月死于肿瘤复发;2例分别于术后第9、14个月发生颈部淋巴结转移。其余患者随访期间生存良好,无明显心肌缺血症状,无明显进食不适症状。结论:经左后外侧切口同期行OPCABG联合食管癌根治术安全可行。
Objective: To investigate the safety, feasibility and efficacy of esophageal cancer radical resection with off-pump coronary artery bypass grafting (OPCABG) in the same period. Methods: Thirteen CHD patients with resectable esophageal cancer were treated with OPCABG combined with esophagectomy via left posterolateral incision. Summary of intraoperative management and perioperative management points. Results: The operation of this group was smooth and no major complication was found. There was no operative death in this group. Among them, one died of nosocomial infection in 30 days after operation. Two patients were treated with tracheal intubation again and were discharged after active treatment. Postoperative complications include atrial fibrillation, atelectasis, pulmonary infection. The average operative time was 424.07 ± 91.68 min, the intraoperative blood loss was 569.23 ± 343.10 m L, and the postoperative hospital stay was 20.00 ± 7.21 d. The patients were followed up for 4 to 40 months. One patient died of tumor recurrence on the 37th month after operation. Two cases had cervical lymph node metastasis at the 9th and 14th month respectively. The remaining patients survived well during follow-up, no obvious symptoms of myocardial ischemia, and no obvious symptoms of eating discomfort. Conclusion: OPCABG combined with esophageal cancer radical resection via the left posterolateral incision is safe and feasible.