CAJ | 학술논문

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1 cm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、Atricure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例患者术前置人起搏器,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.
목적 총결23례전흉강경개량Maze수술치료특발성심방전동(방전)적림상경험.탐토저충신형수술치료특발성방전적안전성、고효성、가행성.방법 자2010년9월지2011년10월,대23례특발성방전환자시행료전흉강경개량Maze수술.본조포괄항심률실상약물치료무효적、도관사빈소융술후복발적、불능내수약물차불합병기타기질성심장병적방전환자,기중진발성방전환자14례(60.9％),지속성방전9례(39.1％).수술절구포괄매측흉벽3개1 cm적강경화조작기계입구.주요방법포괄쌍측폐정맥격리,좌방후벽소융급좌심이절제.술중사용다각도흉강경、Wolf분리기、Coolrail쌍겁사빈소융필、Atricure쌍겁사빈소융겸화EZ45G연조직절봉기.결과 소유환자수술과정순리,술후수방지1년,무위수술사망급졸중발생.술후수방두성심률전복솔:위수술기내23례환자,술후20례(87.0％)성공전위두률,2례환자방전복발,1례환자술전치인기박기,술후전위기박심률.만3개월수방환자23례,기중부1례잉위방전심률,총체방전치유솔체95.7％(22/23);만6개월수방22례,3례위방전심률,2례위방복심률,방전치유솔위77.3％(17/22).결론 수술단기결과초보증명료전흉강경개량Maze수술시일충경제、창상소、치유솔고적방전치료적신기술,이차대지속성방전적치료야유이상료효,시일항구유추엄잠력적방전치료신기술.
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.