【摘要】 目的 通过回顾1例食道癌术后合并冠心病的主动脉瓣病变患者的诊疗过程及国内外类似病例的诊治方式,探讨该类患者的发病机制、临床表现及治疗策略。方法 回顾性分析1例行食道癌根治术、术后常规放射治疗后11年因心脏瓣膜病合并冠心病再次入院接受治疗的患者。结合国内外资料对这类患者的手术指征、发病机制及临床特点进行分析讨论。结果 经胸超声心动图提示主动脉瓣瓣膜钙化,轻度狭窄伴重度反流,冠脉造影提示以左主干病变为主的三支冠状动脉病变。在杂交手术室通过杂交手术的方式,先行经皮冠状动脉支架植入,同期全麻体外循环下行主动脉瓣置换术,该治疗取得成功。结论 恶性肿瘤患者放疗后需长期严密随访,且需要注意激发心脏事件和冠状动脉疾病的发生。对合并冠心病的主动脉瓣病变同期行经皮药物洗脱支架植入及体外循环下主动脉瓣置换术是安全和合适的有效治疗方法。更多还原

【Abstract】 Objective To discuss the pathogenesis,clinical manifestations and surgical choice in patients with valvular disease and coronary artery disease after treatment of esophageal carcinoma from one patient’s treatment procedure and the review of similar cases reported at home and in other countries.Methods One patient with aortic valve disease and coronary artery disease after treatment of esophageal carcinoma 11 years ago was analyzed retrospectively,and this patient received radiotherapy and chemotherapy after esophageal surgery.Based on the domestic and foreign data,the surgical indications,pathogenesis and clinical features of these patients were analyzed and discussed.Results Because of severe aortic regurgitation and coronary artery stenosis,this patient was hospitalized this time for further treatment.Transthoracic echocardiography showed aortic valve calcification,and mild stenosis with severe regurgitation.Coronary angiography showed three branches lesion of the coronary artery,and the unprotected left main coronary artery lesion was severe and revascularization was required.This patient received the hybrid procedure successfully in the hybrid operation room.First,the percutaneous coronary stent implantation procedure was performed successfully by cardiologist,and after that the aortic valve replacement procedure was completed by cardiac surgeon with open chest surgery by using cardiopulmonary bypass.Conclusion Patients with cancer should be followed up for a long time after radiotherapy,and the occurrence of cardiac events and coronary artery disease secondary to the radiotherapy should be paid attention to.The hybrid procedure performed by the cardiologist and the cardiac surgeon is safe and effective for the patient with severe aortic regurgitation and coronary artery disease who has received radiotherapy after esophageal surgery.更多还原