子宫内膜癌合并冠心病患者手术安全性和可行性的临床分析

Clinical analysis of surgical safety and practicability in patients with endometrial carcinoma complicated with coronary atherosclerotic heart disease

目的探讨子宫内膜癌合并冠心病(冠状动脉粥样硬化性心脏病)患者的手术安全性和可行性。方法回顾性分析2014年1月至2019年12月首都医科大学附属北京安贞医院收治的90例子宫内膜癌行手术治疗的患者的临床资料。根据是否合并冠心病,将患者分为冠心病组(子宫内膜癌合并冠心病的患者,32例)和无冠心病组(单纯子宫内膜癌患者,58例)。随访至2020年12月,对2组患者的术中术后临床指标、复发及死亡情况进行统计分析。结果冠心病组和无冠心病组患者年龄、体重指数、肿瘤组织类型、分化程度等级、国际妇产科联盟分类类型方面差异均无统计学意义(均P> 0.05)。冠心病组9例行开腹手术、23例行腹腔镜手术,无冠心病组9例行开腹手术、49例行腹腔镜手术。2组患者手术病理分期、出血量、发热比例、手术入路、不同部位淋巴结阳性比例差异均无统计学意义(均P> 0.05)。术后至随访截止,冠心病组和无冠心病组患者复发率、病死率差异均无统计学意义[15.6%(5/32)比6.9%(4/58)、15.6%(5/32)比8.6%(5/58)](χ^(2)=1.641,P=0.200;χ^(2)<0.001,P=0.993)。Log-rank检验结果显示,2组患者复发时间和死亡时间差异均无统计学意义(χ^(2)=0.960,P=0.327;χ^(2)=0.296,P=0.586)。结论子宫内膜癌合并冠心病的患者手术治疗安全可行,有利于提高患者的生存率。

Objective To investigate the surgical safety and practicability in patients with endometrial carcinoma complicated with coronary atherosclerotic heart disease( CHD). Methods The clinical data of 90 patients with endometrial carcinoma who underwent surgery in Beijing Anzhen Hospital,Capital Medical University from January 2014 to December 2019 were retrospectively analyzed. The patients were divided into CHD group( endometrial carcinoma complicated with CHD,32 cases) and non CHD group( endometrial carcinoma alone,58 cases). All patients were followed-up to December 2020,and the intraoperative and postoperative clinical indexes,recurrence and mortality of the two groups were statistically analyzed. Results There were no significant differences in age,body mass index,tumor tissue type,grade of differentiation,International Federation of Gynecology and Obstetrics classification between the two groups( all P > 0. 05). In CHD group,9 cases underwent open surgery and 23 cases underwent laparoscopic surgery;in non CHD group,9 cases underwent open surgery and 49 cases underwent laparoscopic surgery. There were no significant differences in operative pathological stage,blood loss,fever rate,operative approach and positive rate of lymph nodes in different parts between the two groups( all P > 0. 05). From the end of operation to the end of follow-up,there were no significant differences in recurrent rate and mortality between CHD group and non CHD group[15. 6%( 5/32) vs 6. 9%( 4/58),15. 6%( 5/32) vs 8. 6%( 5/58) ]( χ^(2)= 1. 641,P = 0. 200;χ^(2)< 0. 001,P = 0. 993). Log-rank test showed that there were no significant differences in recurrent time and death time between the two groups( χ^(2)= 0. 960,P = 0. 327;χ^(2)= 0. 296,P = 0. 586).Conclusion Operation is safe and feasible in patients with endometrial carcinoma complicated with CHD,which is beneficial to improve the survival rate of the patients.