| 摘要: |
| 目的评价经右胸微创切口外科治疗左房室瓣病变并同期采用单极冲洗式射频消融术治疗房颤的手术安全性及疗效。方法选取我院2008年1月至2011年12月左房室瓣病变合并房颤患者共60例,经右胸微创切口行瓣膜手术及心内膜射频消融术30例为研究组,经正中切口行瓣膜手术30例为对照组,两组术前资料差异无统计学意义。研究组术中行左房室瓣成形或置换,并应用单极冲洗式射频消融房颤,射频线路以改良迷宫Ⅲ手术为基础。随访并比较分析两组手术疗效、术后并发症及房颤的消除率。结果研究组无中转开胸、再次瓣膜手术、延期拔除气管插管、血红蛋白尿、重要脏器功能衰竭及死亡。与对照组比较,研究组平均主动脉阻断时间和平均体外循环时间延长、胸液量和输血量减少、住院日缩短,两组差异有统计学意义(P<0.05)。研究组和对照组术后即刻、出院时、术后6个月房颤消除率分别为96.7%、66.7%、73.3%和50%、23.3%、16.7%,两组差异有统计学意义(P<0.01)。术后6个月研究组心功能改善情况好于对照组。结论经右胸微创切口实施左房室瓣手术同期行心内膜射频消融术治疗房颤,既达到微创的理念,又能有效处理左房室瓣并消除房颤,并不增加心内手术的风险及并发症,术后早、中期效果理想。 |
| 关键词: 微创 单极射频消融 左房室瓣病变 心房纤颤 |
| DOI：10.3724/SP.J.1008.2012.001212 |
| 投稿时间：2012-09-19修订日期：2012-10-08 |
| 基金项目:国家卫生部公益基金(200802096). |
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| Double atrial ablation with monopolar irrigated radiofrequecy for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy: a clinical controlled study |
| ZHANG Guan-xin,HAN Lin,ZHONG Keng,LI Li,LU Fang-lin,WANG Chong,LI Bai-ling,WANG Jun,XU Zhi-yun* |
(Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To evaluate the safety and efficacy of radiofrequecy ablation for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy. Methods From Jan. 2008 to Dec. 2011, 30 patients underwent radiofrequecy Maze Ⅲ procedure for atrial fibrillation during mini-invasive mitral valve surgery (study group). Another 30 patients with atrial fibrillation undergoing mitral valve surgery through median sternotomy without Maze procedure during the same period were taken as controls. The pre-treatment data of the patients were matchable between the two groups. The study group received mitral valve repair/replacement and radiofrequecy Maze Ⅲ procedure for atrial fibrillation. The operative outcome, postoperative complication and elimination rate of atrial fibrillation were compared between the two groups. Results No patient in the study group was transferred to median sternotomy during operation, and there was no reoperation, prolonged incubation, failure of important organs, hemoglobinuria or death. Compared with the control group, the study group had significantly longer mean circulation arrest time and cardiopulmonary bypass time, significantly reduced chest drainage and blood transfusion volume, and significantly shortened hospital study (P<0.05). The elimination rates of atrial fibrillation at immediately after operation,discharge and 6 months after operation were 96.7%, 66.7% and 73.3% in the study group, and 50%, 23.3% and 16.7% in the control group, respectively, with significant difference found between the two groups (P<0.01). Compared with the control group, better heart function recovery was achieved in the study group at 6 month after operation. Conclusion Radiofrequecy ablation for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy is safe and effective. Importantly, it does not increase risks and complications of surgery. The early and middle term effects are satisfactory. |
| Key words: mini-invasive monopolar radiofrequecy ablation mitral valve lesion atrial fibrillation |
