导尿管引导双极消融钳技术在瓣膜置换同期房颤治疗中的应用  

Urine catheter guided bipolar ablation clamp in surgical treatment of atrial fibrillation associated with valve replacement

作　　者：陈林[1] 肖颖彬[1] 陈柏成[1] 马瑞彦[1] 程伟[1] 郝嘉[1] 

机构地区：[1]第三军医大学新桥医院全军心血管外科研究所,重庆400037

出　　处：《第三军医大学学报》2012年第13期1329-1331,共3页Journal of Third Military Medical University

基　　金：第三军医大学临床科研基金(2010 D254)~~

摘　　要：目的探讨心脏瓣膜置换术中应用双极射频消融治疗房颤更安全、简洁的操作技术。方法建立导尿管引导双极射频消融钳技术,观察在163例瓣膜置换同期消融治疗房颤患者中应用疗效,其中,男性55例,女性108例,年龄27～70岁,平均47.6岁,房颤病史均超过1年,最长15年,左心房最大内径45～80 mm,左心室内径43～74 mm,左心室射血分数40%～70%。本技术在常规体外循环下进行,体外循环转流后依次分离左、右肺静脉,先套过普通尿管,再以导尿管作为牵引,引导双极射频钳通过肺静脉后壁并完整包绕肺静脉,先进行左、右肺静脉消融隔离,再进行左侧上、下肺静脉,上、下肺静脉与左心耳之间的消融,缝闭左心耳,经左房或房间隔径路完成瓣膜置换手术,最后进行右心房消融。结果本技术在163例瓣膜置换术同期双极射频消融患者中应用,手术操作顺利,无组织撕裂,无术中意外出血,以及手术后再止血患者,死亡1例(0.6%),其余均顺利出院。结论该技术简化常规双极射频隔离肺静脉的手术操作技术,有效降低常规双极射频方法的手术风险,减少手术并发症,是一种有效的技术方法。Objectives To investigate a more simple and safe surgical technique for the treatment of atrial fibrillation （AF） with bipolar ablation during the valve replacement. Methods From January 2010 to October 2011, a total of 163 patients were enrolled in this study to investigate the effect of urine catheter-guided bipolar ablation in the surgical treatment of AF, including 55 males and 108 females aged from 27 to 70 years （mean 47.6 years）. All the patients had at least 1 year＇s history of AF, and the longest one was 15 years. Maximum diameter of the left atrium ranged from 45 to 80 mm, diameter of the left ventricle from 43 to 74 mm and ejection fraction of the left ventricle from 40% to 70%. All the procedures were performed under the cardiopulmonary bypass （CPB）. After the start of CPB, the left and right pulmonary veins （PV） were carefully separated and encircled with a urine catheter. With the guidance of the catheter, the bipolar ablation clamps were positioned precisely around the PV. Circle ablation of the right and left PVs was performed, followed by the straight-line ablation between the left inferior and the left atrial appendage. Then, the opening of the superior PVs and between the left PVs and the opening of left atrial appendage was closed with continuous suture, followed by the valve replacement and the ablation of the right atrium. Results This urine catheter-guided bipolar ablation was successfully applied in 163 patients with AF undergoing valve replacement. The surgical process was uneventful in all the patients without any tear of myocardial or vascular tissue and without bleeding events during and after operations. Except for 1 death （0.6%）, all the patients were discharged Conclusion This technique can effectively simplify the procedure of the ablation of PVs, reduce as expected. the associated risk and decrease the incidence of the related complications.

关 键 词：心房纤颤 双极 射频消融术 风湿性心脏病 

分 类 号：R454.1[医药卫生—治疗学] R540.46[医药卫生—临床医学]