摘要
目的总结23例全胸腔镜改良Maze手术治疗特发性心房颤动（房颤）的临床经验。探讨这种新型手术治疗特发性房颤的安全性、高效性、可行性。方法自2010年9月至2011年10月，对23例特发性房颤患者施行了全胸腔镜改良Maze手术。本组包括抗心律失常药物治疗无效的、导管射频消融术后复发的、不能耐受药物且不合并其他器质性心脏病的房颤患者，其中阵发性房颤患者14例（60．9％），持续性房颤9例（39．1％）。手术切口包括每侧胸壁3个1cm的腔镜和操作器械入口。主要方法包括双侧肺静脉隔离，左房后壁消融及左心耳切除。术中使用多角度胸腔镜、Wolf分离器、Coolrail双极射频消融笔、Atrieure双极射频消融钳和EZ45G软组织切缝器。结果所有患者手术过程顺利，术后随访至1年，无围手术死亡及卒中发生。术后随访窦性心律转复率：围手术期内23例患者，术后20例（87．0％）成功转为窦律，2例患者房颤复发，1例患者术前置入起搏器，术后转为起搏心律。满3个月随访患者23例，其中仅1例仍为房颤心律，总体房颤治愈率达95．7％（22／23）；满6个月随访22例，3例为房颤心律，2例为房扑心律，房颤治愈率为77．3％（17／22）。结论手术短期结果初步证明了全胸腔镜改良Maze手术是一种经济、创伤小、治愈率高的房颤治疗的新技术，而且对持续性房颤的治疗也有理想疗效，是一项具有推广潜力的房颤治疗新技术。
Objective To evaluate the safety and feasibility of a completely thoracoscopic modified Maze procedure for treatment of patients with lone atrial fibrillation（AF）. Methods From September 2010 to October 2011, completely thoracoscopic modified Maze procedure was performed in 23 patients with lone atrial fibrillation （ 14 paroxysmal AF and 9 persistent AF）. All patients were either refractory or intolerant to antiarrhythmic drug therapy or already experienced unsuccessful catheter-based ablation. This procedure includes three 1 cm ports for thoracoscopic camera and ablation device on each side of chest wall. Bilaterally pulmonary vine isolation was made by an AtricureTM bipolar radiofrequency device. Two epicardial ablation lines were created on LAPW to connect bilaterally pulmonary vine ablation lesion using Coolrail linear pen. LAA was removed by a Johnson and Johnson EZ45G stapler. Results The procedures were successful in all the patients, 20 patients were in sinus rhythm immediately after surgery, 2 patients were still in AF rhythm and 1 patient in pacing rhythm post surgery. Three-month follow up were finished in 23 patients and there was 1 patient in AF rhythm, 95.7% patients were free of AF; 6-month follow up were finished in 22 patients, 3 patients were in AF rhythm and 2 patients in AFL rhythm, 77. 3% patients were free of AF. Conclusion Our results suggested that the completely thoracoscopic modified Maze procedure is a safe, feasible and effective technique for treating patients with atrial fibrillation.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第8期674-677,共4页
Chinese Journal of Cardiology
关键词
心房颤动
导管消融术
外科手术
微创性
Atrial fibrillation
Catheter ablation
Surgical procedures, minimally invasive
