心房颤动冷冻消融在微创二尖瓣手术中的应用  

Application of cryoablation in minimally invasive mitral valve surgery

作　　者：李小冰[1] 刘立明[1] 宋珑[1] 罗成[1] 杨本利[1] 刘育宏 

机构地区：[1]中南大学湘雅二医院心血管外科,长沙410011

出　　处：《中南大学学报（医学版）》2016年第3期295-299,共5页Journal of Central South University ：Medical Science

摘　　要：目的：总结35例胸腔镜辅助下微小切口二尖瓣手术同期行冷冻消融治疗心房颤动的临床经验,探讨该术式的安全性和有效性。方法：回顾中南大学湘雅二医院心血管外科2013年8月至2015年7月完成的胸腔镜辅助下右胸微小切口二尖瓣手术同期行冷冻消融治疗心房颤动的临床资料。所有患者经股动静脉插管建立体外循环,经由右胸微小切口（4~6 cm）进胸,Chitwood法阻断主动脉,平行右房间沟切开左心房,冷冻消融按改良Maze IV消融线路治疗心房颤动,缝闭左心耳,改良右房冷冻消融线路,同期通过该小切口完成二尖瓣和/或三尖瓣手术。记录体外循环时间、阻断主动脉时间、平均住院日,术后连续3 d监测心律、术后第7天12导联心电图及术后第3,6,12,18个月门诊追踪复查12导联心电图,观察心律情况。结果：全组无死亡,1例再次开胸止血。手术时间（197.4±27.2）min,体外循环时间（103.6±20.3）min,主动脉阻断时间（65.3±15.7）min,术后ICU住院时间（1.2±0.4）d,术后住院时间为（7.6±1.5）d,住院日（9.2±1.6）d。术后即刻窦性心律转复率为97.1%。出院时窦性心律为94.3%。随访无新发死亡病例,术后第3,6,12,18个月的窦性心律分别为94.3%,93.5%,90.5%,93.3%。结论：胸腔镜辅助下微小切口二尖瓣手术合并心房颤动冷冻消融安全可靠、创伤小、心房颤动治疗效果确切,值得推广。Objective： To summarize the clinical data of patients who experienced cryoablation in minimally invasive mitral valve surgery and to explore safety and eff ectiveness of the surgery. Methods： We retrospectively collected the clinical data of patients who experienced cryoablation in minimally invasive mitral valve surgery in Department of Cardiovascular of Second Xiangya Hospital from August 2013 to July 2015. Through a right side（4-6 cm） thoracotomy, femoral cannulation and aortic cross-clamp by Chitwood clamper was performed, left atrium was entered from interatrial groove. Modified left and right side cryomaze followed by valve surgery was finished. The left atrial appendage was excluded by oversewing from endocardial surface. The cardiopulmonary bypass time, cross-clamp time, duration in hospital were recorded. The heart rhythm of 3 consecutive post operation days, at 7th day, 3 months, 6 months, 12 months or 18 months after the surgery was monitered by 12-leads electrical cardiogram. Results： No death was observed in this group. Reexploration for bleeding was conducted for one case. Operation time, CBP time and cross-clamp time was（197.4±27.2）,（103.6±20.3）and（65.3±15.7） min, respectively. Duration in ICU and hospital was（1.2±0.4） and（9.2±1.6） d, respectively. The ratio of sinus rhythm restoration right after surgery was 97.1%. The ratio of sinus rhythm restoration at the time of hospital discharge was 94.3%. No motality was found in followup. The ratio of sinus rhythm restoration at 3, 6, 12,18 months after the surgery was 94.3%, 93.5%, 90.5%, 93.3%, respectively. Conclusion： Right minimal invasive thoracoscopic-assisted cryoablation in mitral valve surgery is quite effective in the treatment of atrial fibrillation, displaying the advantages of less complications, motality and hospitalization.

关 键 词：微创心脏手术 心房颤动 二尖瓣置换 冷冻消融 

分 类 号：R654.2[医药卫生—外科学]