内荷包环缩术行左室室壁瘤心室成形的近远期疗效  

Endoventricular purse-string reconstruction technique:early and long term results

作　　者：凤玮[1] 樊红光[1] 郑哲[1] 胡盛寿[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院,北京100037

出　　处：《中日友好医院学报》2009年第6期340-342,346,共4页Journal of China-Japan Friendship Hospital

基　　金：国家十一五科技支撑计划(2006BAI01A09);北京市科委资助项目(D0906004040391)

摘　　要：目的:评价用内荷包环缩术行左室成形治疗心肌梗死后左室室壁瘤的近远期结果。方法:1995年11月～2005年12月,145例心肌梗死后形成左室室壁瘤的患者在我院用内荷包环缩术行左室成形,同期行冠状动脉旁路移植术。所有患者术前均由超声心动图及左室造影明确诊断。手术均在全麻低温体外循环下进行,术中用1-0prolene线在疤痕组织与心肌组织交界处行环缩后,再用"三明治"法缝合环缩后切口。通过回顾性临床资料分析和随访,用多变量分析法评估手术早期风险因子,用Cox风险比例模型计算远期死亡和再入院率的独立风险预测因子。Kaplan-Meier曲线表示远期生存率。结果:近期死亡率2.8%(4例),远期死亡率11%(16例)。10年随访期间有27.6%(40例)的患者曾再次入院,16.6%(24例)的患者出现不良心脑血管事件(包括心肌梗死、再血管化、心脏性死亡及脑卒中)。没有发现与手术早期死亡相关的风险因子,远期死亡和再入院的独立风险预测因子均是脑卒中史。术后1年和5年生存率分别是95%和86%。术后1年和5年免再住院生存率分别是87%和60%。结论:内荷包环缩术是一种简便而有效的左室成形技术,术后的近远期临床结果良好。Objective：To reconstruct left ventricle with a modified technique in patients with left ventricular aneurysm and evaluate early and long term results.Methods：In 1995 we initiated to use a no-patch technique in patients with dyskinetie left ventricular aneurysm.A total of 145 patients underwent left ventricular reconstruction with this technique from Nov.1995 to Dee.2005 and were followed up successfully.Risk factors for early mortality were analyzed by bivariate analyses.Cox＇s proportional hazard model was used to calculate risk factors for all cause death and readmission.Kaplan-Meier curve was employed to analyze long term survival and readmission-free survival.Results：One week after operation,the left atrial diameter and left ventricular end diastolic diameter decreased.At the same time,left ventricular ejection fraction increased.The early mortality was 2.8%;the long term mortality was 11.0%.During the follow-up period,the rate of readmission was 27.6%. Survival analysis exhibiting the probability of survival at one,five years after operation was 95% and 86%.The probability of readmission-free survival at one and five years after operation was 87% and 60% ,respectively. Conclusion：This technique of left ventricular reconstruction without patch is an effective and concise procedure which can achieve satisfying early and long term results in patients with left ventricular aneurysm.

关 键 词：左心室室壁瘤 内荷包环缩术 

分 类 号：R654.2[医药卫生—外科学]