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| 两种治疗方式对肺癌合并冠心病疗效的对比分析 |
| 张竞1,初向阳1,刘阳1,王云喜1,云天洋1,刘毅1,万峰2,张喆2* |
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(1. 解放军总医院胸外科,北京100853
2. 北京大学第三医院心脏外科,北京100191
*通信作者) |
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| 摘要: |
| 目的 对比研究两种治疗方式治疗肺癌合并冠心病的优缺点,为临床工作提供帮助。方法 回顾分析 2010年12月至2011年12月9例在解放军总医院胸外科先行冠状动脉支架植入术(PCI),术后短期内再行肺癌根治术的肺癌合并冠心病的患者(PCI组),以及8例在北京大学第三医院心脏外科行非体外循环冠状动脉旁路移植术(OPACBG)并同期行肺癌根治术的肺癌合并有严重冠状动脉狭窄的患者(OPACBG组)的病例资料,对两组临床数据进行对比分析。结果 两组患者均无围手术期心肌梗死、肺部感染、切口感染,无二次开胸止血、无围手术期死亡。与PCI组比较,OPCABG组的总手术时间[(428±22) min vs (149±32) min]、术中出血总量[(367±19) ml vs (171±19) ml]、第一个24 h胸腔引流量[(527±17) ml vs (250±14) ml] 均偏高,差异有统计学意义(P<0.01),但两组间肺叶切除手术时间[(158±27) min vs (149±32) min]、术后住院天数[(10±0.5) d vs (11±0.5) d] 差异无统计学意义。 结论 对于合并重度缺血性心脏病的肺癌患者,冠状动脉介入治疗和冠状动脉旁路移植手术各有优势。应根据患者身体状况、冠状动脉病变部位等具体因素,严格按照适应证来选择恰当的血运重建技术,再积极行肺癌根治手术。 |
| 关键词: 肺肿瘤 冠心病 冠状动脉支架植入术 非体外循环冠状动脉旁路移植术 肺切除术 |
| DOI：10.3724/SP.J.1008.2012.00408 |
| 投稿时间：2012-03-13修订日期：2012-04-10 |
| 基金项目: |
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| Two surgical methods in treatment of lung cancer complicated with coronary heart disease: a comparative analysis |
| ZHANG Jing1,CHU Xiang-yang1,LIU Yang1,WANG Yun-xi1,YUN Tian-yang1,LIU Yi1,WAN Feng2,ZHANG Zhe2* |
(1.Department of Thoracic Surgery, General Hospital of PLA, Beijing100853, China
2.Department of Cardiosurgery, the Third Hospital of Peking University, Beijing100191, China
*Corresponding author.) |
| Abstract: |
| Objective To analyze the advantages and disadvantages of two surgical Methods for treatment of lung cancer complicated with coronary heart diseases (CHD), so as to provide evidence for clinical practice. Methods Nine patients with lung cancer complicated with CHD received radical resection of lung cancer shortly after percutaneous coronary intervention (PCI) with stent implantation from Dec. 2010 to Dec. 2011 in the General Hospital of PLA. During the same period eight patients with lung cancer and severe coronary artery stenosis underwent off-pump coronary artery bypass grafting (OPCABG) and radical operation for lung cancer in the Third Hospital of Peking University. The clinical data of the two groups (PCI group and OPCABG group) were analyzed and compared. Results There were no perioperative myocardial infarction, pulmonary infection, incision infection, reoperation due to bleeding, or perioperative death in both groups. Compared with the PCI group, OPCABG group had significantly longer overall operation time ([428±22] min vs [149±32] min), more blood loss ([367±19] ml vs [171±19] ml), and more chest drainage in the first postoperative 24 hours ([527±17] ml vs [250±14] ml, P<0.01). The operation time for lobectomy ([158±27] min vs [149±32] min) and postoperative hospital stay ([10±0.5] d vs [11±0.5] d) were not statistically different between the two groups. Conclusion Coronary intervention and coronary artery bypass grafting have their own advantages in treating lung cancer complicated with severe ischemic heart disease. Appropriate revascularization techniques should be chosen according to indications before radical operation for lung cancer, while considering the patients’ physical condition and specific site of coronary lesions. |
| Key words: lung neoplasms coronary disease coronary stent implantation off-pump coronary artery bypass grafting pneumonectomy |
