两种治疗方式对肺癌合并冠心病疗效的对比分析

目的 对比研究肺癌合并冠心病外科两种治疗方式的优缺点，为临床实践工作提供帮助。方法 回顾 2009 年 12 月 -2011年12月我科9例肺癌合并冠心病患者先行冠脉支架植入术( PCI)，术后短期内再行肺癌根治术的病例资料，以及同一时期北京大学第三医院心胸外科8例合并有严重冠状动脉狭窄的肺癌患者行非体外循环冠状动脉旁路移植术(OPACB)并同期行肺癌根治术的病例资料，将此两组临床数据行对比研究。结果 两组患者均无围手术期心肌梗塞、肺部感染、切口感染，无二次开胸止血、无围手术期死亡。与PCI组相比，OPCAB组的整体手术时间，术中出血、术后第一个24小时胸腔引流量明显偏高（p<0.01），但两组间肺叶切除手术时间、术后住院天数无统计学差异。 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( PCI) 和冠状动脉旁路移植手术( CABG)各有优势。应根据患者身体状况、冠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，再积极进行肺癌根治手术。

Two surgical methods in treatment of lung cancer complicated with coronary heart disease: a comparative analysis

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.