胸腔镜辅助下右胸小切口心脏二尖瓣手术同期房颤消融术的临床研究

Concomitant atrial fibrillation ablation for patients undergoing mitral surgery via mini-thoracotomy with thorascopic assistance

摘要:

目的：探讨胸腔镜辅助下右胸小切口心脏二尖瓣手术同期房颤消融术的临床效果、安全性和可行性。方法：前瞻性对照分析重庆市人民医院心血管外科2016年3月1日至2017年5月10日收治的瓣膜手术加房颤消融的手术患者。根据手术切口类型分为2组，A组（微创组）：胸腔镜辅助下右胸小切口行心脏二尖瓣手术同期房颤消融（13例），B组（传统手术组）：正中胸骨切口心脏瓣膜手术同期房颤消融术（28例）。对照2组术后即刻和术后10 d房颤的转复率、术中房颤消融时间、术后出血引流量、术后切口长度、术后左房直径。结果：微创组有着与传统组相同的房颤转复率，术后即刻（76.9% vs. 78.5%，P=1.000）、术后10 d（84.6% vs. 78.5%，P=0.975），且术中房颤消融时间也无明显差异[（41.9±4.0） min vs. （39.7±5.4） min，P=0.198]。术后左房直径2组间无明显差异[（47.6±6.3） mm vs. （49.5±6.6） mm，P=0.384]。术后出血引流量，微创组明显少于传统组[（342.9±44.3） mL vs.（47.1±132.5） mL，P=0.020]。术后切口长度，微创组明显优于传统组（5.1±0.6） cm vs. （20.7±2.6） cm，P=0.000）。结论：胸腔镜辅助下右胸小切口二尖瓣替换同期房颤消融术在手术创伤和手术出血方面由于传统手术方式，是一种临床上安全、可行的一种手术方式。

Abstract:

Objective：To evaluate the safety and efficacy concomitant atrial fibrillation ablation for patients undergoing mitral surgery via mini-thoracotomy with thorascopic assistance. Methods：From March 1st 2016 to May 10th 2017，41 patients undergoing atrial fibril－lation ablation with valve surgery in Chongqing General Hospital were enrolled and divided into two groups. Two groups were divided by the operational approach. A group were the patients underwent radiofrequecy mazeⅢ procedure during mini-invasive valve surgery. B groups were the patients underwent radiofrequecy mazeⅢ procedure with valve surgery by median sternotomy. The rate of freedom from atrial fibrillation（after procedure：76.9% vs. 78.5%，P=1.000，10 days later：84.6% vs. 78.5%，P=0.975），the time of ablation pro－cedure[（41.9±4.0） min vs. （39.7±5.4） min，P=0.198]，the diameter of left atrium[（47.6±6.3） mm vs. （49.5±6.6） mm，P=0.384]，the volume of chest drainage[（342.9±44.3） mL vs. （47.1±132.5） mL，P=0.020]，the length of the incision[（5.1±0.6） cm vs. （20.7±2.6） cm，P=0.000] were compared between two groups. Results：Compared with B groups，A groups has no difference in the rate of freedom from atial fibrillation；no difference in the time of ablation procedure and the diameter of left atrium was observed. However，there were significant differences in the volume of chest drainage（P=0.020），the length of the incision（P=0.000）. Conclusion：The concomitant atrial fibrillation ablation for patients undergoing mitral surgery via mini-thoracotomy with thorascopic assistance is safe and feasible.