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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)mlvs(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。
Objective To compare the advantages and disadvantages of two kinds of treatment for the treatment of lung cancer with coronary heart disease, and to provide assistance for clinical work. Methods From December 2010 to December 2011, 9 cases of patients with lung cancer complicated with coronary heart disease who underwent radical resection of lung cancer shortly after operation (PCI group) underwent coronary stent implantation (PCI) at the Department of Thoracic Surgery, PLA General Hospital from December 2010 to December 2011, ) And 8 cases of lung cancer with severe coronary artery stenosis (OPACBG group) undergoing off-pump coronary artery bypass grafting (OPACBG) and concurrent radical resection of lung cancer at the Third Hospital of Peking University Third Hospital. The two groups of clinical data for comparative analysis. Results There was no perioperative myocardial infarction, pulmonary infection, incision infection in the two groups of patients, no secondary thoracotomy, and no perioperative death. Compared with the PCI group, the total operative time in OPCABG group was (428 ± 22) min vs (149 ± 32) min, and the total amount of bleeding in the OPCABG group was (367 ± 19) ml vs (171 ± 19) ml There was a statistically significant difference between the two groups (P <0.01), but the time of lobectomy was (158 ± 27) min vs (149 ± 32) min]. There was no significant difference in postoperative hospital stay [(10 ± 0.5) d vs (11 ± 0.5) d]. Conclusion For patients with lung cancer complicated by severe ischemic heart disease, coronary intervention and coronary artery bypass grafting have their own advantages. Should be based on the patient’s physical condition, coronary lesions and other specific factors, in strict accordance with the indications to select the appropriate revascularization technology, and then active radical lung cancer surgery.