食道超声心动图辅助胸腔镜左心耳夹闭术在高栓塞和高出血风险心房颤动患者中的应用  

Application of Transesophageal Echocardiography Assisted Thoracoscopic Left Atrial Appendage Clipping in Atrial Fibrillation Patients With High Risk of Stroke and Bleeding

作　　者：刘胜中[1] 魏大闯 向波[1] 谭今[1] 李文华 黄克力[1] Liu Shengzhong;Wei Dachuang;Xiang Bo(Department of Cardiovascular Surgery,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Affiliated Hospital of University of Electronic Science and Technology,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院电子科技大学附属医院心脏大血管外科,成都610072 [2]四川省医学科学院·四川省人民医院电子科技大学附属医院心血管超声及心功能科,成都610072

出　　处：《中国微创外科杂志》2024年第6期432-437,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：四川省自然科学基金(2023NSFSC0588);四川省人民医院临床研究及转化基金(2021LY08)。

摘　　要：目的探讨食道超声心动图辅助胸腔镜左心耳夹闭术在高栓塞和高出血风险心房颤动患者中的安全性和疗效。方法回顾性分析2021年11月~2023年5月14例高栓塞和高出血风险的心房颤动患者资料。均有脑梗死史,CHA2 DS2-VASc评分3~7分,(5.0±1.4)分;HAS-BLED评分3~4分,(3.3±0.5)分。两孔法胸腔镜手术,食道超声心动图辅助采用国产E-Clip左心耳闭合系统行左心耳夹闭术。结果全组手术均顺利完成,手术时间(39.6±7.7)min,术后总引流量(80.4±37.1)ml,引流管留置时间(26.0±2.5)h。14例随访3~21个月,中位时间8个月。经胸超声心动图显示左心耳夹闭完全,无残余漏,左心房内未见血栓形成。头颅CT未见新发脑梗死或出血灶。心电图提示窦性心律2例,12例仍为心房颤动。结论食道超声心动图辅助胸腔镜左心耳夹闭术能够完全夹闭左心耳,避免高栓塞和高出血风险心房颤动患者新发脑卒中,并对少数患者起到电隔离左心耳的作用而消除心房颤动。Objective To investigate the safety and efficacy of transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping in atrial fibrillation patients with high risk of stroke and bleeding.Methods Clinical data of 14 atrial fibrillation patients with high risk of stroke and bleeding from November 2021 to May 2023 was retrospectively analyzed.All the patients had suffered from cerebral infarction.The CHA2 DS2-VASc score was 3-7(mean,5.0±1.4)and the HAS-BLED score was 3-4(mean,3.3±0.5).The thoracoscopic surgery was performed with two ports.The left atrial appendage clipping was performed by using a domestically produced E-Clip left atrial appendage closure system,assisted by transesophageal echocardiography.Results All the operations were successfully performed.The mean operation time was(39.6±7.7)min,the mean drainage volume after operation was(80.4±37.1)ml,and the drainage tube was removed at(26.0±2.5)h after operation.All the 14 patients were followed up for 3-21 months,with a median of 8 months.Complete closure of the left atrial appendage without residual leakage and no thrombosis in the left atrium were confirmed by transthoracic echocardiography.No new cerebral infarction or bleeding lesions in the brain was detected by CT scanning.The electrocardiogram showed that 2 patients converted to sinus rhythm and 12 patients still maintained atrial fibrillation rhythm.Conclusions Transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping can completely closure left atrial appendage and avoid new onset of stroke in atrial fibrillation patients with high risk of stroke and bleeding.It can also play a role in electrical isolation of left atrial appendage so as to cure atrial fibrillation in few patients.

关 键 词：左心耳夹闭术 胸腔镜手术 食道超声心动图 心房颤动 脑卒中 高出血风险 

分 类 号：R654.2[医药卫生—外科学]