- 期刊
Concomitant Myocardial Revascularization and Modified Radical Mastectomy: Report of a Case
同次施行心肌血管再造術及改良式乳房根除術：病例報告
摘要
我們報告一例成功的聯合手術，這是在八十一歲病人身上同時施行的混合式血管再造術及改良式乳房根除術。她遭逢兩年的胸痛病史，並且後來被證實她有含三條血管之冠狀動脈疾病，其中右冠狀動脈屬於慢性完全阻塞而由其餘兩條供應側枝循環。她從一年前開始注意到左乳房的腫瘤，經檢查後發現是左側乳癌，並無淋巴結或遠處轉移。在評估過手術風險、可能的併發症及預後，我們採取了一個混合式的治療：首先她接受左迴旋支的經皮冠狀動脈血管成型術，之後我們為她進行同一傷口的微創冠脈搭橋術及改良式乳房根除術合併腋下淋巴節清除。術後病人恢復良好，兩年追蹤期間並無癌症再發或胸痛發生。同時施行之混合式血管再造術及改良式乳房根除術似乎可成此類病人另一合理的選擇。
關鍵字
無資料並列摘要
We report a successful concomitant myocardial revascularization with modified mastectomy on a female octogenarian. This patient had suffered from chest tightness for two years, and was proved to have triple-vessel coronary artery disease (CAD) with significant stenotic lesions on her left anterior descending (LAD) and circumflex coronary artery in addition to total occlusion of her right coronary artery with collateral circulation from the left side coronary artery. She also had a palpable mass in her left breast for one year that was proved to be cancer of the breast later. After evaluation of surgical risk, possible complications and prognosis in a combined conference, our surgical team decided to perform percutaneous transluminal coronary angioplasty (PTCA) for circumflex coronary artery first. Then we performed a concomitant minimally invasive direct coronary artery bypass (MIDCAB) with left internal thoracic artery (ITA) bypassing to LAD and a left modified mastectomy with axillary node dissection at the same time through the same surgical incision. The patient withstood the procedure well and was followed up 24 months later without any evidence of recurrence of chest discomfort or the breast cancer. A combination of myocardial revascularization and modified mastectomy seems to be an alternative strategy for patients with CAD and cancer of the left breast.
延伸閱讀
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