| 摘要: |
| 目的 对比一种新型精准手术系统与传统手术器械在肥厚型梗阻性心肌病（HOCM）外科治疗中的应用效果。方法 采用8只4个月龄雄性广西巴马小型猪制备HOCM模型，然后随机分为对照组和实验组（每组4只）。两组均由同一团队行改良扩大Morrow手术; 切除肥厚室间隔组织时，对照组应用镰状刀片等传统手术器械，实验组应用新型精准手术系统。分别于术前24 h、术后72 h由同一医师进行心脏超声检查，测定左心房前后径、室间隔厚度、左心室舒张末期内径、左心室流出道平均压差、左心室射血分数、二尖瓣收缩期前向活动（SAM）征、二尖瓣反流量，并采用化学发光法检测血清心力衰竭评估指标N末端脑钠肽前体（NT-proBNP）的水平。结果 实验组的体外循环时间、主动脉阻断时间均短于对照组（P均＜0.05）。术后对照组和实验组的室间隔厚度、左心室流出道平均压差、左心房前后径、左心室射血分数、二尖瓣反流量和血清NT-proBNP水平均低于术前（P均＜0.05）。术后实验组的室间隔厚度、左心室流出道平均压差和血清NT-proBNP水平均低于术后对照组（P均＜0.05）。术后72 h，对照组和实验组HOCM猪均存活，各有1只HOCM猪发生主动脉瓣损伤，均无左束支传导阻滞和医源性室间隔穿孔。结论 与传统手术器械相比，新型HOCM精准手术系统能切除肥厚的室间隔心肌组织并缩短手术时间、改善近期治疗效果，且不增加术后早期并发症发生率和死亡率。 |
| 关键词: 肥厚型梗阻性心肌病 新型精准手术系统 外科治疗 治疗结果 动物模型 |
| DOI：10.16781/j.CN31-2187/R.20210708 |
| 投稿时间：2021-07-19 |
| 基金项目:海军军医大学(第二军医大学)第二附属医院转化医学孵育基金(ZHFY2019-01) |
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| Application of a new precision surgical system in treatment of hypertrophic obstructive cardiomyopathy model pigs |
| YANG Qian,LING Xin-yu,XUE Xiao-fei,XIAO Jian,XI Wang,WANG Zhi-nong* |
(Department of Cardiovascular Surgery, The Second Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To compare the efficacy of a new precision surgical system and traditional surgical instruments in the treatment of hypertrophic obstructive cardiomyopathy (HOCM).Methods Eight 4-month-old male Guangxi Bama miniature pigs were used to prepare HOCM models, and were randomly divided into control group (n＝4) and experimental group (n＝4). The pigs in both groups underwent modified extended Morrow procedure by the same team. The ventricular septal hypertrophy tissues were removed in the control group with traditional surgical instruments such as sickle blade, while in the experimental group with a new precision surgical system. Echocardiography was performed by the same physician 24 h before and 72 h after surgery. Anteroposterior diameter of the left atrium, interventricular septal thickness, left ventricular end-diastolic diameter, mean pressure difference of left ventricular outflow tract (LVOT), left ventricular ejection fraction, systolic anterior motion (SAM) of the mitral valve, and mitral valve regurgitation were measured. Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level was detected by chemiluminescence method.Results The extracorporeal circulation time and aortic occlusion time in the experimental group were significantly shorter than those in the control group (both P < 0.05). The postoperative interventricular septal thickness, mean pressure difference of LVOT, anteroposterior diameter of left atrium, left ventricular ejection fraction, mitral valve regurgitation, and serum NT-proBNP level were significantly lower than preoperative ones in both groups (all P < 0.05). The postoperative interventricular septal thickness, mean pressure difference of LVOT and serum NT-proBNP level of the experimental group were significantly lower than those of the control group (all P < 0.05). All HOCM pigs survived 72 h after surgery, aortic valve injury was detected in 1 HOCM pig in each group, and there were no left bundle branch block or iatrogenic ventricular septal perforation.Conclusion Compared with the traditional surgical instruments, the new HOCM precision surgical system can accurately remove the ventricular septal hypertrophy tissues, significantly shorten the operative time and improve the short-term treatment outcome without increasing the early postoperative complications or mortality. |
| Key words: hypertrophic obstructive cardiomyopathy new precision surgical system surgical treatment treatment outcome animal models |
