2019 年第 12 期 第 14 卷

有严重内科合并症的妇科恶性肿瘤患者行手术治疗的临床分析

Clinical analysis of surgical treatment for gynecological malignant tumor with severe internal comorbidities

作者：赵文娟李斌

英文作者：

单位：100029首都医科大学附属北京安贞医院妇产科

英文单位：

关键词：妇科恶性肿瘤；围术期；外科重症监护病房

英文关键词：

• 摘要：

• 【摘要】目的    探讨有严重内科合并症、术后需入住外科重症监护病房（SICU）的妇科恶性肿瘤患者行手术治疗的临床可行性。方法    回顾性分析2014年1月至2017年12月首都医科大学附属北京安贞医院收治的有严重内科合并症、经相关科室会诊术后需入住SICU的妇科恶性肿瘤患者105例，对其肿瘤类型、术前合并症、术前准备、手术情况及术后并发症等临床资料进行分析。结果    在105例患者中，子宫内膜癌59例、卵巢上皮性癌（卵巢癌）29例、子宫颈癌17例。有24例（22.9%）术前有1种内科合并症，余 81例（77.1%）有2种或2种以上内科合并症。心血管疾病包括高血压83例、冠状动脉粥样硬化性心脏病34例、心律失常27例、心脏结构异常（房间隔缺损、室间隔缺损、瓣膜病等）17例，脑血管疾病包括脑梗死史或脑出血史11例，内分泌疾病包括糖尿病34例、甲状腺功能亢进2例，肺部疾病包括慢性阻塞性肺疾病4例。术前经相关科室会诊，根据手术要求给予药物治疗，控制血压在140～150/90～100 mmHg（1 mmHg=0.133 kPa）以下，空腹血糖＜8.0 mmol/L，餐后血糖≤10.0 mmol/L，肺最大通气量＞60%，心功能至基本正常。该105例患者术前经麻醉科评估及处理均顺利完成手术，65例（61.9%）行腹腔镜手术，40例（38.1%）接受开腹手术，无围术期死亡。住院期间出现术后并发症者15例（14.3%），包括切口愈合不良2例、下肢静脉血栓7例、菌血症1例、肺栓塞5例、尿潴留2例（其中有2例患者同时发生下肢静脉血栓和肺栓塞），经积极治疗后均好转或治愈。67例（63.8%）患者接受术后辅助化疗，未出现严重放化疗不良反应。结论    有严重内科合并症的妇科恶性肿瘤患者经充分的术前评估、积极处理术前合并症和围术期多学科联合诊治，手术治疗是安全、可行的。

• 【Abstract】Objective    To explore the clinical feasibility of surgical treatment for gynecological malignant tumor with serious internal comorbidities that need admission to surgery intensive care unit（SICU）. Methods    From January 2014 to December 2017, 105 patients with gynecological malignant tumor and severe internal comorbidities that needed preoperative multidisciplinary consultation and postoperative hospitalization in SICU underwent surgery in Beijing Anzhen Hospital, Capital Medical University. Clinical data including tumor type, type of comorbidities, preoperative preparation, surgical records and postoperative complications were retrospectively analyzed. Results    Among the 105 cases there were 59 cases of endometrial cancer, 29 cases of ovarian epithelial cancer(ovarian cancer) and 17 cases of cervical cancer. Twenty-four patients(22.9%) had 1 comorbidity and 81 patients(77.1%) had 2 or more comorbidities. Cardiovascular comorbidities included hypertension in 83 cases, coronary atherosclerotic heart disease in 34 cases, arrhythmia in 27 cases and abnormal heart structure(atrial septal defect, ventricular septal defect, valvular disease) in 17 cases. Eleven patients had histories of cerebral infarction or cerebral hemorrhage. Endocrine comorbidities included diabetes in 34 cases and hyperthyroidism in 2 cases. Four patients had chronic obstructive pulmonary disease. Preoperative medication was performed according to the consultation results to maintain blood pressure below 140-150/90-100 mmHg, fasting blood sugar＜8.0 mmol/L, postprandial blood sugar≤10.0 mmol/L, maximum pulmonary ventilation reaching 60%, and heart function indicators were basically normal. All patients successfully completed operation; 65 cases（61.9%） had laparoscopic operation and 40 cases（38.1%） had open surgery, and none of them died during perioperative period. Postoperative complications occurred in 15 patients（14.3%） during hospitalization, including 2 cases of poor incision healing, 7 cases of venous thrombosis of lower extremities, 1 case of bacteremia, 5 cases of pulmonary embolism and 2 cases of urinary retention(2 patients had both venous thrombosis and pulmonary embolism), which were all cured after treatment. Sixty-seven patients（63.8%） had postoperative adjuvant chemotherapy with or without radiotherapy and no severe complication related to radio-chemotherapy was reported. Conclusion    Surgical treatment is safe and feasible in gynecological malignant tumor patients with severe internal comorbidities after adequate preoperative assessment, comorbidity control and multidisciplinary intervention.