2021 年第 6 期 第 16 卷

经皮冠状动脉介入术后抗血小板治疗患者子宫内膜癌分期手术安全性观察

Safety of staging operation for endometrial cancer in patients treated with antiplatelet therapy after percutaneous coronary intervention

作者：杨艳芬张军

英文作者：Yang Yanfen Zhang Jun

单位：首都医科大学附属北京安贞医院妇产科100029

英文单位：Department of Obstetrics and Gynecology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：子宫内膜癌分期手术；经皮冠状动脉介入；抗血小板治疗

英文关键词：Stagingsurgeryforendometrialcancer;Percutaneouscoronaryintervention;Antiplatelettherapy

• 摘要：

• 目的 探讨经皮冠状动脉介入（PCI）术后抗血小板治疗患者行子宫内膜癌分期手术的安全性。方法 选取2016年8月至2020年9月首都医科大学附属北京安贞医院收治的接受过PCI手术的26例早期子宫内膜癌患者作为观察组，目前均正接受规范抗血小板药物治疗，选取同期不合并冠状动脉粥样硬化性心脏病且未接受抗栓治疗的早期子宫内膜癌患者168例作为对照组。2组均拟在全身麻醉下行腹腔镜子宫内膜癌分期手术，术后均给予低分子肝素预防血栓。比较2组术前与术后的血红蛋白、血小板计数（PLT）、花生四烯酸（AA）和二磷酸腺苷（ADP）途径血小板聚集率、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、国际标准化比值(INR)、D-二聚体水平，术中出血量、手术时间，并统计术后主要不良心血管事件、出血及深静脉血栓发生情况。结果 2组手术前后组间及组内血红蛋白、PLT、PT、APTT、FIB、INR比较差异均无统计学意义（均P＞0.05）。观察组术前与术后AA、ADP途径血小板聚集率均低于对照组［术前：（48±13）%比（65±12）%、（39±8）%比（71±10）%；术后：（54±18）%比（78±21）%、（38±9）%比（78±13）%］（均P＜0.05）。2组患者术后D-二聚体水平均明显高于术前（均P＜0.05）。2组手术时间、术中出血量比较，差异均无统计学意义（均P＞0.05）。所有患者均未发生围术期死亡、急性心肌梗死、肺栓塞等严重并发症。观察组发生1例心房颤动和1例心绞痛，对症治疗后均恢复。2组均无因术后出血多需二次开腹手术者。2组深静脉血栓发生率比较差异无统计学意义（P＞0.05）。结论 术前充分评估出血及血栓风险，维持稳定凝血功能，围术期继续原抗血小板治疗不明显增加术中出血量，PCI术后可以安全实施腹腔镜下子宫内膜癌分期手术。

• Objective To investigate the safety of staging surgery for endometrial cancer in patients with antiplatelet therapy after percutaneous coronary intervention (PCI). Methods From August 2016 to September 2020, 26 patients with early endometrial cancer who underwent PCI and received regular antiplatelet therapy in Beijing Anzhen Hospital, Capital Medical University were selected as the observation group.  One hundred and sixty-eight patients with early stage endometrial carcinoma without coronary atherosclerotic heart disease and antithrombolytic therapy were selected as the control group. The 2 groups were scheduled to undergo laparoscopic surgery for endometrial carcinoma under general anesthesia, and low molecular weight heparin was given after operation to prevent thrombosis. The levels of hemoglobin, platelet count (PLT), arachidonic acid (AA) and adenosine diphosphate (ADP) pathway platelet aggregation rate, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR), D-dimer, intraoperative blood loss and operation time were compared between the two groups before and after operation. The postoperative incidences of major adverse cardiovascular events, bleeding and deep venous thrombosis(DVT) were analyzed. Results There were no significant differences in hemoglobin, PLT, PT, APTT, FIB and INR between the 2 groups before and after operation (all P＞0.05). Before and after operation, the AA and ADP pathway platelet aggregation rate in observation group were lower than those in control group ［before operation: （48±13）% vs （65±12）%, （39±8）% vs （71±10）%; after operation: （54±18）% vs （78±21）%,（38±9）% vs （78±13）%］(all P＜0.05). The level of D-dimer in both groups after operation was significantly higher than that before operation (all P＜0.05). There was no significant difference in operative time and blood loss between the two groups (both P＞0.05). No serious complications such as perioperative death, acute myocardial infarction and pulmonary embolism occurred in patients. One case of atrial fibrillation and one case of angina pectoris occurred in the observation group, and they both recovered after symptomatic treatment. The two groups had no postoperative bleeding and no need to secondary operation. There was no significant difference in the incidence of DVT between the two groups (P＞0.05). Conclusions  The risk of bleeding and thrombosis is fully assessed preoperatively, and stable coagulation function is maintained. Continuance of primary antiplatelet therapy during perioperative period do not significantly increase intraoperative blood loss, and laparoscopic staging surgery for endometrial cancer after PCI can be safely performed.