冠心病支架植入术后2周行胸腔镜下肺癌根治术的围术期处理体会  

Perioperative management for patients with thoracoscopic radical resection of lung cancer at two weeks after stent implantation for coronary heart disease

作　　者：张芳[1] 徐凯[1] 游庆军[1] 过晶[1] ZHANG Fang;XU Kai;YOU Qingjun;GUO Jing(The Affiliated Hospital of Jiangnan University,Wuxi,Jiangsu,214062)

机构地区：[1]江南大学附属医院,江苏无锡214062

出　　处：《实用临床医药杂志》2018年第7期16-18,22,共4页Journal of Clinical Medicine in Practice

基　　金：江苏省333项目(BRA2014044);江苏省无锡市医学重点人才项目(RC2016013)

摘　　要：目的探讨合并有严重冠脉狭窄的肺癌患者在冠脉支架植入术后2周行全胸腔镜下肺癌根治术的安全性和可行性。方法回顾性分析13例合并有严重冠脉狭窄在冠脉支架植入术(PCI)后2周行全胸腔镜下肺癌根治术的患者的临床资料,并收集同时期内未合并严重冠脉狭窄,未行PCI治疗的胸腔镜下肺癌根治术127例患者的临床资料作对比研究。结果PCI组13例共植入25枚支架,其中左前降支12枚,左回旋支6枚,右冠状动脉7枚。PCI过程顺利,冠脉狭窄程度均由75%以上降至10%以下。2组患者均顺利在全麻胸腔镜下行肺癌根治术,术后病理均证实为癌。PCI组凝血时间(TT)较对照组显著延长(P<0.05),血小板计数(PLT)较对照组显著减少(P<0.05),而凝血酶原时间(PT)和活化的部分凝血活酶时间(APTT)无显著差异(P>0.05)。2组手术时间、术中出血量无显著差异(P>0.05)。相对于对照组,虽然PCI组术后胸腔引流量显著增加(P<0.05),术后拔管时间和住院时间较对照组显著延迟(P<0.05),但PCI组术中及术后未出现大量出血,也未出现重大的心血管意外。结论在规范应用抗凝药物、做好围术期工作的前提下,冠脉支架植入术后2周行胸腔镜下肺癌根治术是安全可行的。Objective To investigate the safety and feasibility of thoracoscopic radical resection of lung cancer in patients with severe coronary stenosis at 2 weeks after stent implantation.Methods Clinical materials of 13 patients with thoracoscopic radical resection of lung cancer at 2 weeks after stent implantation for coronary heart disease were analyzed retrospectively,and were compared with the clinical materials of 127 patients without severe coronary artery stenosis by thoracoscopic radical resection for lung cancer.Results Totally 13 patients in PCI group were implanted with 25 stents.Among them,12 stents were smoothly implanted in left anterior descending branch,6 stents in left circumflex branch and 7 stents in right coronary artery.The degree of coronary artery stenosis decreased from more than 75%to less than 10%.The patients in two groups were smoothly performed thoracoscopic radical resection of lung cancer under general anesthesia,and postoperative pathology was confirmed as malignant tumor.Blood coagulation time(TT)in PCI group was significantly longer than that in the control group(P<0.05),platelet count(PLT)decreased significantly when compared with the control group(P<0.05),and the prothrombin time(PT)and activated partial thromboplastin time(APTT)showed no significant differences between two groups(P>0.05).The operating time and the bleeding volume in two groups showed no significant differences(P>0.05),while the postoperative pleural drainage in PCI group significantly increased(P<0.05),extubation time and postoperative hospitalization time were significantly longer than those in the control group(P<0.05),but in PCI group,there was no massive bleeding during and after operation,and no major cardiovascular accident occurred.Conclusion It is safe and feasible to use thoracoscopic radical surgery of lung cancer at 2 weeks after coronary artery stent implantation on the premise of standardized anticoagulant drugs and good perioperative jobs.

关 键 词：冠脉支架植入术 肺癌根治术 胸腔镜 抗凝治疗 

分 类 号：R734.2[医药卫生—肿瘤]