Cox迷宫Ⅲ型手术同期换瓣治疗风湿性二尖瓣病变伴房颤  

Cox/maze III procedure combined with mitral valve replacement in treatment of rheumatic mitral valve disease with atrial fibrilation

作　　者：陈如坤[1] 王永清[2] 陈勇兵[1] 陈锁成[3] 

机构地区：[1]浙江大学医学院附属第二医院胸心外科,杭州310009 [2]浙江大学医学院附属邵逸夫医院 [3]镇江市第一人民医院

出　　处：《中华医学杂志》2002年第12期815-817,共3页National Medical Journal of China

摘　　要：目的　观察换瓣同时作Cox迷宫Ⅲ型手术与单独换瓣相比较的疗效。方法　选择单独换瓣 +迷宫Ⅲ型手术病例 (迷宫组 )与这一期间另外所作的单独换瓣病例 (对照组 )各 5 6例 ,均系风湿性病变、心功能Ⅲ～Ⅳ级、慢性持续性心房纤颤 1年以上。术后均用华法林抗凝治疗。结果　主动脉阻断时间和心脏停搏时间迷宫组较对照组长 ,分别为 75min± 2 2min对 4 1min± 11min(P <0 0 5 )和12 4min± 4 0min对 6 8min± 19min(P <0 0 5 )。复跳后出血迷宫组 2例 ,对照组 1例 ,均止血有效。两组术后早期死亡率均为 1 8% (1/ 5 6 )。迷宫组术后窦性心律者占 98 2 % (5 4 / 5 5 ) ,在作最大体力活动时无窦性迟钝现象 ,均有心房收缩功能 ;术后 1年 ,心功能Ⅰ级者占 98 2 % (5 4 / 5 5 ) ,Ⅱ级 1 8% (1/5 5 ) ;无抗凝严重出血 ,亦无血栓栓塞并发症 ;晚期死亡率 1 8% (1/ 5 5 )。对照组中 7例在术后 2 4h内心房纤颤曾暂时消失 ,以后仍为慢性心房纤颤 ,而另有 1例心房纤颤长期消失已 2年 ;术后 1年 ,心功能Ⅰ级者占 94 6 % (5 2 / 5 5 ) ,Ⅱ级占 3 6 % (2 / 5 5 ) ,Ⅲ级占 1 8% (1/ 5 5 ) ;无抗凝严重出血 ,脑栓塞偏瘫 1例 ,占 1 8% (1/ 5 5 ) ;晚期死亡率 3 6 % (2 / 5 5 )。结论　换瓣同期行迷宫Ⅲ型手术安全有效 ,能消除?Objective To compare the curative effect of Cox/maz III procedure combined with mitral replacement and that of mitral valve replacement (MVR). Methods Fifty six patients suffering from rheumatic heart disease with atrial fibrilation (AF) were treated by Cox/maze III procedure combined with MVR (maze group). Another 56 age, sex, and heart function matched patients with the same diagnosis underwent MVR alone during the same period. Warfarin was administered after operation in both groups. Comparison of operative complication and curative effects was made. Results The aortic cross clamp time and cardiopulmonary bypass time (CPB) were longer in maze group than in MVT group (75±22 min vs 41±11 min, P <0.05 and 124±40 min VS 68±19 min, P <0.05). Bleeding happened after the heart reatored beating in 2 patients in maze group and in one patient in MVT group, all these 3 patients responding satisfactorily to hemostasis. The early post operative mortality was 1.79% (1/56) in both groups. In maze group, AF disappeared in all patients but one who had node rhythm. Normal sinus rhythm was restored in 98.18% of the patients (54/55). Atrial contractility was restored in all patients with sinus rhytjm. One year after operation, 98.18% patients′ cardiac function changed to grade and 1.82% changed to grade II. In MVR group AF diasappeared after operation temporarily for 24 hours in 7 patients and re appeared, and AF disappeared in one patients for 2 years so far. One year after operation, the cardiac function of 94.6% patients in MVR group changed to grade I, of 3.6% patients to grade II, and of 1.8% patients to grade III. No serious hemmorrhage related to anticoagulant therapy heppened. One patient in MVR group suffered from hemiplegia due to cerebral embolism. The late mortality was 1.8% on maze group amd 3.6% in MVR group. Conclusion Cox/maze III procedure combined with NVR is safe and effective in treating rheumatic heart disease with AF.

关 键 词：Cox迷宫Ⅲ型手术 治疗风湿性二尖瓣病变 房颤 二尖瓣替换术 

分 类 号：R654.2[医药卫生—外科学]