狭心症と進行胃癌に対する同時手術の１例

概要

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A 72-year-old man was successfully treated with simultaneous minimally invasive direct coronary artery bypass grafting (MIDCAB)and total gastrectomy.The patient was admitted to our hospital due to chest pain with anemia (Hb 11.3g/dl).A coronary angiogram showed a 90% occlusion of the right coronary artery and a 75% occlusion of the left anterior descending coronary artery. Endoscopic examination revealed gastric cancer (Borrmann type Ⅲ). Therefore, we carried out MIDCAB and total gastrectomy with lymph node dissection simultaneously.First,the left internal thoracic artery(LITA)was anastomosed to the left anterior descending artery through the left anterior small thoracotomy. After closing the left thoracic wall, total gastrectomy with lymphnode dissection was done. During surgery the patient’s hemodynamic condition remained stable with no electrocardiographic changes. Postoperative coronary angiography was done one week after the operation;the LITA was patent and catheter intervention was performed in the right coronary atery. Off-pump CABG is advantageous for patients who have significant coronary artery disease with malignant neoplasm.
信州医学会の論文
2000-12-10