CAJ | 학술논문

目的探讨盒式消融术式能否提高心房颤动(房颤)治疗的成功率.方法 2009年1至12月,心脏直视手术同期行改良迷宫手术患者中,行左心房后壁盒式消融术者60例,同期配对选择60例非盒式消融术者作为对照组.两组均经过相对一致的术前检查和围手术期处理.结果除盒式消融组体外循环时间较长外,两组在年龄、房颤时间、左心房直径、左心室射血分数、同期手术等差异无统计学意义,两组围手术期均无死亡病例.所有病例均顺利随访,平均(9.0±8.4)个月.盒式消融组1例在术后2个月死于脑出血,非盒式消融组1例在术后12个月出现脑梗塞.术后1与3个月,两组免于房颤率分别为70.0％对51.2％(P=0.039)与78.3％对60.0％ (P =0.030)；术后6个月分别为80.0％对71.7％ (P =0.286).8例因房颤心律复发再次入院,两组分别有4例和2例行导管消融,两组各有1例行电复律,均恢复窦性心律,并继续口服胺碘酮治疗3个月.结论盒式消融组通过增加左、右肺静脉之间连线,比非盒式消融组左、右肺静脉之间单一连线,明显提高射频消融迷宫手术后早期(1～3个月)窦性心律的维持率；但在术后半年,两组窦性心律的维持率差异无统计学意义.
목적 탐토합식소융술식능부제고심방전동(방전)치료적성공솔.방법 2009년1지12월,심장직시수술동기행개량미궁수술환자중,행좌심방후벽합식소융술자60례,동기배대선택60례비합식소융술자작위대조조.량조균경과상대일치적술전검사화위수술기처리.결과 제합식소융조체외순배시간교장외,량조재년령、방전시간、좌심방직경、좌심실사혈분수、동기수술등차이무통계학의의,량조위수술기균무사망병례.소유병례균순리수방,평균(9.0±8.4)개월.합식소융조1례재술후2개월사우뇌출혈,비합식소융조1례재술후12개월출현뇌경새.술후1여3개월,량조면우방전솔분별위70.0％대51.2％(P=0.039)여78.3％대60.0％ (P =0.030)；술후6개월분별위80.0％대71.7％ (P =0.286).8례인방전심률복발재차입원,량조분별유4례화2례행도관소융,량조각유1례행전복률,균회복두성심률,병계속구복알전동치료3개월.결론 합식소융조통과증가좌、우폐정맥지간련선,비비합식소융조좌、우폐정맥지간단일련선,명현제고사빈소융미궁수술후조기(1～3개월)두성심률적유지솔；단재술후반년,량조두성심률적유지솔차이무통계학의의.
Objective Background and objective The Cox maze Ⅲ procedure has been considered the gold standard for the surgical treatment of atrial fibrillation (AF) and the modified Cox maze use bipolar radiofrequency ablation instead of the cut-and-sew technique,while also reducing the connecting lines in left atrium.This study was to understand whether completely isolation the posterior left atrium by increasing left atrium ablation lines can enhance the survival after modified Cox maze procedure.Methods From Jan 2009 to Dec 2009,all the patients underwent the Cox maze procedure,following the same examination,were divided into two groups (case-control): box lesion group (n =60),which is means the right and lefi pulmonary vein lesions were connected inferiorly by adding ablation lines,thereby completely isolating the posterior left atrium and the non-box lesion group (n =60).Similar interventions were given during the perioperative periods.Comparing the risk factors before surgeries,then follow-up was 100％ complete,and the mean follow-up was 9 ± 8.4 months.Results Except the box lesion had long time of extracorporeal circulation,the characteristics of the 2 groups were similar because there were no differences in age,AF duration,left atrial diameter,left ventricular ejection fraction or homochronous operation between the groups and there was no operative death.No patient was lost to follow-up.In the mean follow-up duration,a patient was died of intracerebral hemorrhage at 2 months postoperationly in the box lesion group and a patient suffered from stroke at 12 months postoperationly in the non-box lesion.The overall freedom from AF recurrence was higher in the box lesion group at 1 (70％ vs 51.2％,P =0.039) and 3 (78.3％ vs 60％,P =0.030) months.While it was 80％ vs 71.7％ (P =0.286) at 6 months.Eight patients wrere readmitted because of the recurrence of AF,4 and 2 patients underwent catheter ablation in box and non-box group respectively,one patient in each group underwent electrical conversion.After treatment,all of the patients were recovered to sinus rhythm and continued to take cordarone.Conclusion Compared to the single connecting between right and left pulmonary vein,isolating the entire posterior left atrium by creating a box lesion showed higher freedom from AF in the earlier months (1-3months).However,half a year after the surgery,there were no significant differences between the two groups.