Objective: To examine the prognosis factors of postoperative cardiac complications in colorectal cancer patients co-morbidated with coronary artery disease. Methods: Clinical data of 449 patients colorectal cancer patients co-morbidated with coronary artery disease accepted redical surgery from April 2013 to April 2020 at Department of General Surgery, Peking Union Medical College Hospital were analyzed retrospectively. There were 306 males and 143 females, aging (68.7±8.9) years (range: 44 to 89 years). Postoperative acute coronary syndrome, new-onset arrhythmia and heart failure that causes clinical symptoms were recorded as cardiac complications. t test, χ2 test and Fisher exact test were used for univariate analysis of prognosis factors of postoperative cardiac events. The variables with P<0.05 were included in the multivariate Logistic regression was used to determine the independent prognosis factors. Results: After surgery, 44 patients (9.8%) suffered from at least one cardiac event, including 30 patients with acute coronary syndrome, 19 patients with new-onset arrhythmia and 9 patients with heart failure. There were 3 deaths in the cohort within 30 days after surgery. Two patients died from cardiac-related complications, and one from septic shock due to postoperative anastomotic leaks. On Univariate analysis showed that cardiac complications were associated with age ≥80 years, co-morbidated diabetes, emergency surgery, re-operation, anastomotic leakage, intestinal flora disorder and elevation of preoperative neutrophil-lymphocyte ratio (χ2: 4.308 to 12.219, all P<0.05). Multivariate Logistic regression analysis identified age ≥80 years(OR=3.195, 95%CI: 1.379 to 7.407, P=0.007), co-morbidated diabetes (OR=2.551, 95%CI: 1.294 to 5.025, P=0.007), emergency surgery (OR=4.717, 95%CI: 1.052 to 20.833, P=0.043), and elevated preoperative neutrophil-lymphocyte ratio (OR=1.114, 95%CI: 1.018 to 1.218, P=0.018) as independent prognosis factors for cardiac complications. Conclusions: Emergency surgery, advanced age, co-morbidated type 2 diabetes and elevated preoperative neutrophil-lymphocyte ratio may increase the risk of postoperative cardiac complications in colorectal cancer patients with coronary artery disease. Surgeons should strictly master surgical indications, pay attention to preoperative assessment, perioperative monitoring, and diagnosis and treatment of postoperative complications in order to reduce the risk of complications.
目的： 探讨合并冠心病的结直肠癌患者根治性手术后发生心脏并发症的预后因素。 方法： 回顾性分析2013年4月至2020年4月在北京协和医院基本外科接受根治性手术的449例合并冠心病的结直肠癌患者资料。男性306例，女性143例，年龄（68.7±8.9）岁（范围：44~89岁）。统计术后心脏并发症，包括新发急性冠状动脉综合征、引起临床症状的新发心律失常和心力衰竭等。采用t检验、χ²检验或Fisher确切概率法进行心脏并发症预后因素的单因素分析，采用Logistic回归进行多因素分析。 结果： 44例（9.8%）患者术后至少发生1次心脏并发症，其中急性冠状动脉综合征30例次，新发心律失常19例次，心力衰竭9例次。经心内科会诊后予积极扩张血管、抗血小板/抗凝治疗、控制心率或利尿等支持治疗后，42例患者病情好转。术后30 d内3例死亡，2例死于心脏并发症，1例死于吻合口漏所致感染性休克。单因素分析结果显示，年龄≥80岁、合并2型糖尿病、急诊手术、二次手术、吻合口漏、术后肠道菌群失调、术前中性粒细胞与淋巴细胞比值升高与术后心脏并发症有关（χ²值：4.308~12.219，P值均<0.05）。多因素分析结果，年龄≥80岁（OR=3.195，95%CI：1.379~7.407，P=0.007）、合并2型糖尿病（OR=2.551，95%CI：1.294~5.025，P=0.007）、急诊手术（OR=4.717，95%CI：1.052~20.833，P=0.043）、术前中性粒细胞与淋巴细胞比值升高（OR=1.114，95%CI：1.018~1.218，P=0.018）是术后心脏并发症的独立预后因素。 结论： 急诊手术、高龄、合并2型糖尿病和术前中性粒细胞与淋巴细胞比值升高的合并冠心病的结直肠癌患者接受根治性结直肠切除术后发生心血管并发症风险较高。严格把握手术适应证，重视术前评估、围手术期监测和及术后并发症的诊治，可降低并发症风险。.