摘要目的 对比分析右胸微创切口与胸骨正中切口二尖瓣手术同期应用双极射频消融钳作双房消融治疗房颤的效果.方法 2010年1月至2015年1月,二尖瓣手术同期应用双极射频消融钳行Cox MazeⅣ手术152例,右胸微创切口69例,胸骨正中切口83例;男65例,女87例,年龄43 ～ 72岁.术前诊断:风心病97例,退行性病变55例.房颤病程1.5年至13年,均为长程持续性房颤.左心房直径42～ 60 mm;左心室射血分数0.41～0.67.所有患者均在全麻体外循环心脏停跳下采用双极消融钳行双房消融术.消融操作完毕,探查二、三尖瓣的病变情况,行瓣膜修复或置换术.结果 全组均顺利完成心脏瓣膜手术及Cox MazeⅣ手术,微创组无术中转为正中手术者.围手术期死亡1例,系正中切口组患者,术后23天因多脏器功能衰竭死亡.出院时,143例(143/151,94.7％)维持窦性心律,其中微创手术组65例(65/69,94.2％),正中手术组78例(78/82,95.1％) (P=1.000).术后随访6～ 66个月,132例(132/151,87.4％)维持窦性心律;微创手术组62例(62/69,89.9％),正中手术组70例(70/82,85.4％).术后2年累计窦性心律维持率,微创手术组(85.1±5.8)％,正中手术组(88.6±3.6)％,两组无明显差异(P =0.767).结论 对于二尖瓣病变合并房颤的患者,右胸微创切口二尖瓣手术同期双极钳消融房颤可达到与胸骨正中切口相似的治疗效果,且创伤更小、术后恢复更快,并具有良好的美容效果.

abstractsObjective To compare the outcomes of right minithoracotomy or conventional median sternotomy for patients undergoing mitral valve surgery and atrial fibrillation(AF) ablation with bipolar radiofrequency clamp.Methods All 152 patients who received mitral valve surgery and concomitant Cox Maze Ⅳ ablation with entirely bipolar radiofrequency clamp through right minithoracotomy(RM,n =69) or conventional median sternotomy(MS,n =83) from January 2010 to January 2015 were analyzed for outcome differences.The etiology of mitral valve disease was rheumatic(n =97) and degenerative(n =55).Age at operation ranged from 43 to 72 years.Diameter of the left atrium ranged from 42 to 60 mm.Left ventricular ejection fraction ranged from 0.41 to 0.67.AF duration ranged from 1.5 to 13 years.All patients were long-standing persistent AF.Results All patients successfully underwent mitral valve surgery and concomitant Cox Maze Ⅳ ablation with bipolar radiofrequency clamp.There was one early death in conventional sternotomy group in perioperation.At discharge,maintenance of normal sinus rhythm was 94.2％ in RM group and 95.1％ in MS group(P =1.000).Follow-up time ranged from 6 to 66 months.Sinus rhythm was restored in 132 patients(132/151,87.4％).Among them,sinus rhythm was restored in 62 patients (62/69,89.9％) in RM group and 70 patients(70/82,85.4％) in MS group.Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was(85.1 ± 5.8) ％ in RM group and(88.6 ± 3.6) ％ in MS group(P =0.767).Conclusion Right minithoracotomy can achieve the similar therapeutic effect to conventional median sternotomy for patients undergoing mitral valve surgery and concomitant Cox Maze Ⅳ ablation with entirely bipolar radiofrequency clamp.In addition,patients through right minithoractomy had faster recover and better cosmetic outcome.