虚血性心疾患を併存する一般外科手術-とくに胸腹部悪性腫瘍症例-

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  • OPERATION AT THE GENERAL SURGERY FOR COMBINED ISCHEMIC HEART DISEASE

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In trvrmy 4-year period, a total of 536 patients underwent general surgical operation for some lesion of the respiratory system, thyroid gland, breast, and abdominal area at the department. Of these 536 patients, selective coronary angiography was performed in 29 patients (5.4%) who showed either angina, an abnormal resting electrocardiogram, or a positive exercise or stres test. There were 16 patients (55%) with angiographic evidence of coronary stenosis, greater than 0.5 points accoding to Leaman et al's scoring system for rating the severity of coronary stenosis. All patients had some form of malignant disease (2 lung cancers, 5 gastric cancers, 5 colonic cancers, 2 liver cancers, 1 gall bladder cancer, and 1 uterine cancer). Of these the 16 patients with ischemic heart disease, 9 patients (56%) underwent coronary revascularization. An one-stage operation was performed in 4 patients, 2 with gastric cancer, 1 with liver cancer, and 1 with uterine cancer. Three patients (1 with gastric cancer, 1 with gallbladder cancer, 1 with colon cancer) underwent a two-stage operation. Another 2 patient, 1 with gastric cancer and 1 with colon cancer, underwent percutaneous coronary revascularization. Six patients, 2 with lung cancer, 1 with gastric cancer, 1 with liver cancer, and 2 with colon cancer, underwent an abdominal surgery alone.<br> There were no perioperative death. patients with coronary stenosis were divided into 2 groups according to whether or not they underwent coronary revascularization. Patients were assigned to either of the 2 groups according to the established indication criteria for the perfomance of preoperative coronary angiography and standerdization of coronary stenotic lesions. Curative operation for cancers was possible in patients having ischemic heart disease, once the surgeons had knowledge and skills with regard to the management of cancer patients complicated by coronary stenosis.

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