全胸腔镜或胸腔镜辅助微创小切口行左心耳夹闭手术的效果分析  

Analysis of the effect of totally thoracoscopic versus thoracoscopic-assisted minimally invasive small incision surgery in left atrial appendage clipping

作　　者：姚青 叶聪 刘飞 马浩 徐东 YAO Qing;YE Cong;LIU Fei;MA Hao;XU Dong(Department of Cardiac and Vascular Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing,100070,P.R.China)

机构地区：[1]首都医科大学附属北京天坛医院心脏及大血管外科,北京100070

出　　处：《中国胸心血管外科临床杂志》2023年第12期1709-1713,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：首都医科大学附属北京天坛医院人才引进基金(XD 2020-2023)。

摘　　要：目的 比较全胸腔镜与胸腔镜辅助小切口行左心耳夹闭的手术效果。方法 回顾性分析北京天坛医院2018年11月—2022年3月全胸腔镜或胸腔镜辅助小切口下行左心耳夹闭手术患者的临床资料。根据手术方式将患者分为全胸腔镜组和小切口组,比较两组患者的临床结果。结果 共纳入41例患者,其中男30例、女11例,平均年龄(66.6±6.1)岁。全胸腔镜组23例,小切口组18例。心房颤动血栓危险度评分(4.5±1.1)分,抗凝出血评分(3.7±1.5)分。全组无死亡病例。两组在手术时间、胸部并发症、左心耳闭合成功率、左心耳残留长度、心耳夹移位等方面差异均无统计学意义(P>0.05)。全胸腔镜组术后总引流量明显少于小切口组,差异有统计学意义(P=0.031)。中位随访时间10(1~30)个月,随访期间,两组出现脑梗死、左心房血栓各1例。结论 全胸腔镜左心耳夹闭比胸腔镜辅助小切口手术创伤小,未增加手术并发症风险。Objective To compare the surgical effects of totally thoracoscopic and thoracoscopic-assisted small incision for left atrial appendage clipping.Methods The clinical data of patients who underwent left atrial appendage clipping surgery via totally thoracoscopy or thoracoscopic-assisted minimally invasive small incision from November 2018 to March 2022 in Beijing Tiantan Hospital were retrospectively analyzed.According to the surgical approach,they were divided into a totally thoracoscopic group and a small incision group.The clinical results were compared between the two groups.Results A totoal of 41 patients were enrolled,including 30 males and 11 females,with an average age of 66.6±6.1 years.There were 23 patients in the totally thoracoscopic group and 18 patients in the small incision group.The CHA2DS2-VASc score was 4.5±1.1 points,and HAS-BLED score was 3.7±1.5 points.No death occured in the whole group.There was no statistical difference between the two groups in terms of operation time,chest complications,successful rate of closure of the left atrial appendage,residual length of the left atrial appendage,or displacement of the atrial appendage clip(P>0.05).The total drainage volume in the totally thoracoscopic group was less than that in the small incision group,and the difference was statistically significant(P=0.031).The median follow-up time was 10(1-30)months,during which there was 1 patient of stroke and 1 patient of left atrial thrombus in both groups.Conclusion Totally thoracoscopic left atrial appendage clipping is less invasive than thoracoscopic-assisted minimally invasive small incision surgery and does not increase the risk of surgical complications.

关 键 词：全胸腔镜 胸腔镜辅助 左心耳夹闭 微创 

分 类 号：R654.2[医药卫生—外科学]