全腔镜改良Mini-Maze术治疗非阵发性心房颤动——单中心30例临床分析  

Totally thoracoscopic modified Mini-Maze procedure for non-paroxysmal atrial fibrillation:single center experience of 30 consecutive patients

作　　者：刘健[1] 郭惠明[1] 黄帅[1] 谢斌[1] 张煜源 刘方舟[1] 詹贤章[1] 薛玉梅[1] 方咸宏[1] 廖洪涛[1] LIU Jian;GUO Hui-ming;HUANG Shuai;XIE Bin;ZHANG Yu-yuan;LIU Fang-zhou;ZHAN Xian-zhang;XUE Yu-mei;FANG Xian-hong;LIAO Hong-tao(Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2018年第4期412-415,共4页South China Journal of Cardiovascular Diseases

基　　金：广东省科技计划项目(项目编号:2014A020212403;2017S020215054);广东省医学科技研究项目(项目编号:A2016367);广州市科技计划项目(项目编号:2014Y2-00196;158100073)

摘　　要：目的总结全腔镜改良Mini-Maze术治疗非阵发性心房颤动(atrial fibrillation,AF)的临床经验和近期随访结果。方法选择2016年1月至2016年11月在广东省人民医院采用全腔镜改良Mini-Maze术治疗孤立性非阵发性AF的患者30例,男20例,女10例,年龄(59±9.8)岁,其中11例持续性AF,19例长程持续性AF。手术于全胸腔镜下施行,根据手术入路不同,分为双侧胸壁双孔入路组及左后外侧胸壁三孔入路组。结果全组无围术期死亡。1例(3%)左后外胸入路组患者中转开胸。1例(3%)术后因病态窦房结综合征需植入永久起搏器。患者术后住院时间为(8.1±4.8)d,术后重症监护病房停留时间为(18.3±5.9)h,出院时16例(53.3%)为窦性心律,9例(30%)为AF心律,5例(16.7%)为心房扑动心律。术后随访(6.9±2.5)个月,8例(26.6%)维持AF,2例(6.7%)转为心房扑动,20例(66.7%)维持窦性心律。复发的5例患者在术后3~4个月接受再次导管消融,4例转为窦性心律,最后随访时窦性心律转复率为80%(24/30)。围术期及随访期间,无死亡、卒中、左心房血栓和肺静脉口狭窄发生。结论全腔镜改良Mini-Maze法治疗非阵发性AF疗效满意。本研究首创的双侧双孔入路安全、可重复性强,值得进一步推广。Objectives To analyze the short-term results and clinical experience of the totally thoracoscopic modified Mini-Maze procedure for patients with non-paroxysmal atrial fibrillation(AF).Methods From January to November 2016,30 patients(20 male and 10 female)with non-paroxysmal AF in Guangdong General Hospital were underwent totally thoracoscopic modified Mini-Maze procedure.Mean age of these patients was(59±9.8)years.Eleven patients were diagnosed as persistent AF and 19 patients were diagnosed as long-standing persistent AF.According to the modified Mini-Maze procedure performed under totally thoracoscopy:patients were divided into left posterior-lateral chest wall approach(L-MMP)group and bilateral double-port chest wall approach(B-MMP)group.Results The inhospital mortality of the patients was zero.One patient(3%)in L-MMP group was converted to sternotomy.One patient(3%)was implanted permanent pacemaker because of sick sinus syndrome after operation.Post operation in-hospital duration was(8.1±4.8)d,post operation intensive care unit duration was(18.3±5.9)h.At discharge,sinus rhythm was identified in 16 patients(53.3%),AF rhythm in 9 patients(30%)and atrial flutter(AFL)rhythm in 5 patients(16.7%).Follow-up duration was(6.9±2.5)months.AF were identified in 8 patients(26.6%),AFL in 2 patients(6.7%)and sinus rhythm in 20 patients(66.7%).Five cases underwent transcatheter ablation after 3-4 months,4 cases returned to sinus rhythm,and the final success rate of returning sinus rhythm was 80%(24/30).During follow-up period,no death,stroke,left atrial thrombus and pulmonary vein stenosis were recorded.Conclusions Short-term results of to?tally thoracoscopic modified Mini-Maze procedure in patients with non-paroxysmal AF are satisfactory.The novel bilat?eral double-port approach is feasible and safe,and deserved to be promoted in future.

关 键 词：心房颤动 改良迷宫术 外科消融 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]