OPCAB同时行左心室室壁瘤缝缩术206例  

Plicafion of left ventricular aneurysm during off-pump coronary artery bypass surgery

作　　者：于洋[1] 顾承雄[1] 韦华[1] 陈长城[1] 方颖[1] 刘锐[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2007年第3期154-155,共2页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的尝试非体外循环冠状动脉旁路移植术同时进行室壁瘤缝缩术,并评估其疗效。方法选取2001年1月至2006年6月间206例左室室壁瘤病人进行手术。病人术前均存在心绞痛症状,同时伴心功能不全或室性心律失常。心功能为Ⅱ～Ⅳ级。术前射血分数平均0.41±0.06,左心室舒末内径平均(57.4±6.8)mm。不停跳下进行室壁瘤线性缝缩,比较术前及术后相关心功能指标。结果住院死亡1例,病死率0.5%(1/206例)。平均移植血管(2.9±0.9)支。复查时所有病人均无症状。心功能及射血分数均显著提高(P<0.001)。左心室舒末内径显著缩小(P<0.001)。结论在非体外循环冠状动脉旁路移植同时进行室壁瘤缝缩术是可行的,手术死亡率低、并发症少。术后早期心功能、自觉症状及生活质量均显著改善。远期疗效尚需观察。Objective To evaluate the results of a modified linear plication of left venticular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 to June 2006, 206 patients were operated on for nonmptured postinfarction left ventricular aneaurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischemia and allowed assessment of wall function and viability. All patients presented with stnotins of angina and congestive heart failure or ventricular arrhythmia. The NYHA functional class of the patients ranged from grade Ⅱ to grade Ⅳ. Preoperative ejection fraction and left ventricular end-diastolic diameter were 0.41 ± 0.06 and （57.4 ± 6.8）mm. The venatricular preoerafive and postoperstive peromances were compared. Results Hospitalmortalitywas0.5%（l/206）. Coronary artery bypass was peffonned with an average of 2.9 ±0.9 grafts per patient. At the time of follow-up, all the patients had no symptoras. The mean NYHA class and ejection fracrice increased significantly（ P 〈0.001 ）. The mean left ventricular end-diastolic diameter decreased significantly（ P 〈0.001）. Conclusion These results suggest surgical plication of left ventricular aneurysm can be perfomed during off-pump conrouary artery bypass. The operation is associated with a low in-hospital mortality and morbidity. An improvemet in the early-term cardiac functions and symptoms and quality of life was documented, an increased long-term survival may be expected.

关 键 词：心脏室壁瘤 冠状动脉分流术 线性缝缩术 

分 类 号：R654.2[医药卫生—外科学]