胸腔镜辅助下微创射频消融手术治疗心房颤动临床分析  

Video-assisted minimally invasive cardiac surgery for atrial fibrillation： a report of 57 cases

作　　者：崔永强[1] 孟旭[1] 李岩[1] 高峰[1] 李晖[1] 许春雷[1] 曾文[1] 韩杰[1] 

机构地区：[1]北京安贞医院心房颤动诊疗中心心脏外科九病房,100029

出　　处：《中华外科杂志》2008年第14期1051-1053,共3页Chinese Journal of Surgery

摘　　要：目的探讨胸腔镜辅助下微创射频消融手术治疗心房颤动的技术和早期疗效。方法2006年12月至2007年10月，共有57例心房颤动患者接受了胸腔镜辅助下微创心脏手术，其中男性40例，女性17例，平均年龄56．4岁，术前心房颤动病史（5．7±4．5）年。本组阵发性心房颤动38例，持续性心房颤动7例，长期存在的持续性心房颤动12例；3例患者曾行导管消融治疗，2例已安置永久性起搏器。所有患者均在胸腔镜辅助下实施双侧肺静脉前庭射频消融隔离、心外膜部分去迷走神经化治疗、左心耳切闭（Wolf Mini—maze手术）；并在消融前后行心外膜电生理标测。结果本组患者平均手术时间3．5h；术中发现左心房血栓1例，1例患者同期行心外膜的心脏同步化手术。无围手术期死亡；1例术后并发急性呼吸功能不全，1例并发急性心功能不全。共16例患者术后及随访期间行胸外直流电复律治疗；全组患者出院时、术后1、3及6个月窦性心律的比例分别为78．9％（45／57）、64．3％（36／56）、83．9％（47／56）和87．0％（20／23）；术前阵发性心房颤动患者则为84．2％（32／38）、67．6％（25／37）、86．5％（32／37）和89．5％（17／19）。全组随访1～10个月无血栓及栓塞事件发生。结论胸腔镜辅助微创心脏外科手术主要适用于阵发性心房颤动患者，其早期疗效理想，创伤小，安全性高。Objective To evaluate the feasibility and the efficacy of a new video-assisted minimally invasive surgery for patients with atrial fibrillation （AF）. Methods From December 2006 to October 2007, 57 patients who were 56.4 years old in average underwent the video-assisted minimally invasive cardiac operation for AF, and there were 40 male patients. Thirty-eight patients were paroxysmal AF, 7 patients were persistent and 12 patients were long-standing pemistent. Three patients had failed catheter ablation, and two patients had preoperative permanent pacemaker implantation. All patients went under the minimally invasive procedure. Intraoperative electrophysiological mapping were performed. Results Mean operation time was 3.5 h. One patient was confirmed of left auricle thrombus, and one received concurrent epicardial cardiac resynehronization therapy during the procedure. There were no perioperative deaths. Acute respiratory failure occurred in 1 patient and acute heart failure in 1 patient after operation. Sixteen patients had electrical cardiovemion after operation and during follow-up. At discharge, 78.9% （ 45/57 ） of all patients were in sinus rhythm （ 84. 2% for paroxysmal AF, 71.4% for persistent AF, 66. 7% for longstanding persistent AF）. The patients were followed-up by 1 to 10 months. At 1 month after operation, overall 64. 3% （36/56） were in sinus rhythm （67. 6% for paroxysmal AF, 57. 1% for persistent AF, 58.3% for long-standing persistent AF）. At 3 months, overall 83. 9% （47/56） were in sinus rhythm （86. 5% for paroxysmal AF, 85.7% for persistent AF, 75.0% for long-standing persistent AF）. At t〉 6 months, overall 87.0% （20/23） were in sinus rhythm （ 89. 5% for paroxysmal AF, 75.0% for persistent AF）. No thromboembolic event was observed during follow-up period. Conclusion The video-assisted minimally invasive cardiac surgery proves to be safe, less traumatic, and presents optimistic early outcomes for paroxysmal AF patients.

关 键 词：心房颤动 心脏外科手术 外科手术 微创性 

分 类 号：R654.2[医药卫生—外科学]