Can high-risk pulmonary nodules with coronary heart disease be operated?
A 79-year-old female patient was admitted some time ago. Physical examination reveals pulmonary nodules, about 1.5 cm in diameter, mixed with density-ground-glass nodules. If there are signs of malignancy, consider a high-risk nodule and recommend surgery.
The patient's family told me: "The elderly have high blood pressure and diabetes for many years, and if they are not well controlled, is the risk very high?"
I told the family: "If the patient has comorbidities, he can be admitted to the hospital and consult with relevant experts for effective control, and the control is within a controllable range, and he can be operated." ”
After admission, endocrinology and cardiology experts should be consulted to adjust the medication to effectively control blood sugar and blood pressure.
Electrocardiogram (ECG) showed that the patient had myocardial ischemia, and cardiologists recommended coronary angiography. The results suggest that the patient has 80% to 90% coronary stenosis of the left anterior descending artery. This result suggests that the patient has severe coronary artery disease.
The risk of direct surgery is too high, and coronary stent treatment is recommended. Later, he was transferred to the cardiology department for stent therapy.
After 3 months of oral clopidogrel and aspirin 2 anticoagulants after stent treatment, he came to our department again and rechecked various indicators, and there was no obvious abnormality. Clopidogrel was stopped for one week, and anticoagulation was replaced with low-molecular-weight calcium. After the preoperative preparation, there was no obvious contraindication to surgery, and thoracoscopic left upper apical posterior segment resection was performed, and the patient recovered well after surgery and was discharged on the 4th day after surgery.
Postoperative examination reports invasive early-stage lung adenocarcinoma, and regular re-examination is sufficient.
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