中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (02): 135-137.

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胃肠道肿瘤并存冠心病围手术期处理52例分析

查勇1a，寸英丽1a，黄云超1b，陈真1a，杨步荣1a，张麒1a，陈训如2   

  1. 1昆明医学院临床肿瘤学院 a.腹部外科 b.胸心血管外科，云南昆明650118； 2成都军区昆明总医院，云南昆明650032
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-03-03 发布日期:2009-03-03

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-03-03 Published:2009-03-03

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摘要：

目的 探讨胃肠道肿瘤病人合并冠心病的围手术期处理方法。 方法 回顾性分析2007年7月至2008年8月昆明医学院临床肿瘤学院诊治52例胃肠道肿瘤并存冠心病病人的临床资料。术前评估和处理参照2007年美国心脏病学会美国心脏病学院（ACC/AHA）指南。 结果 冠脉造影支架置入5例， 气囊扩张15例，β1受体阻断剂等药物综合治疗32例。病人术后30d内发生心脏相关的并发症8例(15.4%)，其中急性心衰1例(1.9%)，心肌梗死死亡2例（3.8%），心绞痛复发3例（5.8%），难治性心律失常2例（3.8%）。 结论 合并冠心病的胃肠道肿瘤病人在围手术期间风险较高，参照ACC指南，采用多学科协作的术前评估和处理有助于降低心脏并发症的发生率。

关键词: 胃肠道肿瘤； 冠心病, 围手术期处理

Abstract:

Perioperative management of gastrointestinal neoplasms complicated with coronary artery disease: an analysis of 52 cases ZHA Yong*, CUN Ying-li, HUANG Yun-chao, et al. *Department of Abdominal Surgery, Affiliated Tumor Hospital of Kunming Medical College, Kunming 650118, China Corresponding author：HUANG Yun-chao, E-mail: huangych@yahoo.com.cn Abstract Objective To study the strategies of the perioperative management of gastrointestinal neoplasms complicated with coronary artery disease. Methods The clinical data of 52 cases of gastrointestinal neoplasms complicated with coronary artery disease admitted from July 2007 to August 2008 at the Affiliated Tumor Hospital of Kunming Medical College were analyzed retrospectively. All the cases had been assessed and managed according to ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Results Perioperative managements included revascularization with stents in 5 cases, revascularization with only balloon in 15 cases, systemic medical therapy in 32 cases. Postoperative 30 day complications occurred in 8 cases (15.4%), including acute congestive heart failure in 1 case （1.9%）, acute myocardial infarction and death in 2 cases (3.8%), relapsing angina in 3 cases （5.8%), intractable cardiac arrhythmia in 2 cases （3.8%）. Conclusion Successful perioperative evaluation and management of high risk cardiac cases undergoing noncardiac surgery requires careful teamwork and communication between surgeon, anesthesiologist, cardiologist according to ACC/AHA 2007 Guidelines.

Key words: gastrointestinal neoplasms, coronary artery disease, perioperative care