中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (26): 4187-4193.doi: 10.3969/j.issn.2095-4344.1358

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机械瓣膜或生物瓣膜置换及经典迷宫Ⅲ型手术治疗心房颤动合并巨大左心房和风湿性二尖瓣病变

谢赛旗1，2，王辉山2，韩劲松2，尹宗涛2，韩  冰3
  

  1. 1锦州医科大学研究生学院，辽宁省锦州市  121001；2北部战区总医院心血管外科，辽宁省沈阳市  110016；3大连医科大学，辽宁省大连市  116044
  • 收稿日期:2019-04-18
  • 通讯作者: 韩劲松，博士，副主任医师，硕士生导师，北部战区总医院(原沈阳军区总医院)，辽宁省沈阳市 110016
  • 作者简介:谢赛旗，男，1993年生，安徽省阜阳市人，锦州医科大学在读硕士，规培于北方战区总医院(原沈阳军区总医院)，主要从事心血管外科领域心脏瓣膜病和迷宫手术研究。
  • 基金资助:

    2017年辽宁省自然基金计划重点项目(20170540977)，项目负责人：韩劲松

Cut-and-sew maze procedure and mitral valve replacement in the treatment of atrial fibrillation associated with giant left atrium and rheumatic mitral valve disease

Xie Saiqi1,2, Wang Huishan2, Han Jinsong2, Yin Zongtao2, Han Bing3 
  

  1. 1Graduate School, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China; 2Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China; 3Dalian Medical University, Dalian 116044, Liaoning Province, China
  • Received:2019-04-18
  • Contact: Han Jinsong, MD, Associate chief physician, Master’s supervisor, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
  • About author:Xie Saiqi, Master candidate, Graduate School, Jinzhou Medical University, Jinzhou 121001, Liaoning Province, China; Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
  • Supported by:

    the Natural Science Foundation of Liaoning Province (Key Program), No. 20170540977 (to HJS)

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摘要：

文章快速阅读：

 

文题释义：
巨大左心房：风湿性二尖瓣病变和房颤病史较长者常引起左心房增大，而临床上对于巨大左心房的诊断标准不一，常以左房前后径55，60，65，70 mm作为巨大左心房的诊断标准，而临床和科学研究最常以60 mm作为巨大左心房的诊断标准。
经典迷宫Ⅲ手术：1991年Cox报道1例迷宫手术治疗心房颤动以来，心房颤动的外科治疗有了很大进展，手术术式从Ⅰ型、Ⅱ型发展到至今的Ⅲ型，其手术方法为进行心房多个切口，应用“切开和缝合”的方式来阻断心房内及心房周围的折返环，并保留特定的心房传导路径使窦性激动能够传至房室结，这一手术方式称为“经典迷宫Ⅲ手术”。
 
 
背景：外科治疗心房颤动合并巨大左心房和风湿性二尖瓣病变是难点，因为复发率高。迷宫Ⅲ型手术是治疗房颤的“金标准”，但迷宫Ⅲ型手术治疗心房颤动合并巨大左心房和风湿性二尖瓣病变的研究甚少。
目的：研究机械瓣膜或生物瓣膜置换和迷宫Ⅲ型手术治疗房颤合并巨大左心房和风湿性二尖瓣病变患者安全性和有效性。
方法：纳入2014年4月至2017年10月在北部战区总医院心血管外科确诊为房颤合并风湿性二尖瓣病变并行机械瓣膜或生物瓣膜行二尖瓣置换和迷宫Ⅲ型手术的患者114例，将左心房内径<60 mm的85例患者归为非大左房组，左心房内径≥60 mm的29例患者归为大左房组，比较两组围术期安全性指标和术后疗效指标。试验已通过北部战区总医院(原沈阳军区总医院)伦理委员会审核，伦审k(2015)33号。
结果与结论：①术中安全性指标：两组术中体外循环时间、主动脉阻断时间、术中失血量、手术时间及机械瓣膜或生物瓣膜置换类型比较差异均无显著性意义(P > 0.05)；②术后安全性指标：两组术后二次开胸比例、术后行电复律比例、术后临时起搏器应用比例及呼吸机使用时间、ICU停留时间、术后住院时间、术后早期引流量比较差异均无显著性意义(P > 0.05)，两组术后早期并发症发生率比较差异无显著性意义(P > 0.05)；③术后疗效分析：两组术后当天、出院时、术后6个月、术后1年窦性心律转复率比较差异无显著性意义(P > 0.05)，两组术后6个月、1年的心功能恢复情况比较差异无显著性意义(P > 0.05)；④结果表明：机械瓣膜或生物瓣膜置换和经典迷宫Ⅲ型手术治疗房颤合并巨大左心房和风湿性二尖瓣病变安全性较好，近期疗效满意。

关键词: 迷宫手术, 二尖瓣置换, 心脏, 风湿性瓣膜病, 巨大左心房, 心房颤动, 安全性, 有效性

Abstract:

BACKGROUND: The surgical treatment of atrial fibrillation associated with giant left atrium and rheumatic mitral valve disease is still a challenge, because the recurrence rate is high. Cut-and-sew maze procedure is the gold standard for the treatment of atrial fibrillation, but few studies are reported on cut-and-sew procedure used to treat this disease. 
OBJECTIVE: To evaluate the safety and efficacy of cut-and-sew maze procedure and mitral valve (mechanical valve and biovalve) replacement in the treatment of atrial fibrillation associated with giant left atrium and rheumatic mitral valve disease.
METHODS: Patients with atrial fibrillation associated with rheumatic mitral valve disease who underwent the cut-and-sew maze procedure and mitral valve replacement in our hospital during April 2014 to October 2017 were retrospectively analyzed; 114 patients were enrolled according to the inclusion and exclusion criteria. By defining 60 mm as the boundary of the left atrial dimension, patients were divided into a non-giant left atrium group (left atrial dimension < 60 mm, n=85) and a giant left atrium group (left atrial dimension ≥ 60 mm, n=29). Perioperative safety indexes and postoperative curative effect were compared between the two groups. This study was approved by the Ethics Committee of General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Region), China (approval No. lunshen-k(2015)33).
RESULTS AND CONCLUSION: Intraoperative safety indexes: There were no significant differences in the time of aortic occlusion, intraoperative cardiopulmonary bypass, intraoperative blood loss, operation duration and mitral valve replacement type between the two groups (P > 0.05). Postoperative safety indexes: There were no significant differences in the proportion of secondary thoracotomy after surgery, proportion of electrical cardioversion and temporary pacemaker applications, the time of ventilator use, ICU stay, length of hospitalization, early postoperative drainage volume and the incidence of early postoperative compilations between non-giant left atrium and giant left atrium groups (P > 0.05). Postoperative efficacy analysis: there was no significant difference in the recovery rate of sinus rhythm between non-giant left atrium and giant left atrium groups on the day of surgery, at discharge, and 6 months and 1 year after surgery (P > 0.05). There was no significant difference in cardiac function recovery between non-giant left atrium and giant left atrium groups at 6 months and 1 year after surgery (P > 0.05). These results suggest that cut-and-sew maze procedure and mitral valve replacement for the treatment of atrial fibrillation associated with giant left atrium and rheumatic mitral valve disease are highly safe and exhibit encouraging short-term efficacy.

Key words: cut-and-sew maze procedure, mitral valve replacement, heart, rheumatic mitral valve disease, giant left atrium, atrial fibrillation, safety, efficacy

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