CAJ | 학술논문

目的：比较直视下射频消融改良迷宫Ⅲ术（RFMM Ⅲ）＋心脏神经节丛（GP）消融术与单纯 RFMM Ⅲ术治疗合并风湿性二尖瓣病变的心房纤颤疗效。方法回顾性分析因风湿性二尖瓣病变合并心房纤颤接受 RFMM Ⅲ术＋心脏 GP 消融术100例（GP 组）及同期行单纯 RFMM Ⅲ术100例（单纯组）患者的资料，对两组患者围手术期与1、6、12个月随访期内的各项临床指标进行比较分析。结果术后1、6、12个月的随访中，GP 组窦性心律者均高于单纯组（P 依次为0．03、0．02及0．03）。术后12个月随访结果显示单纯组三尖瓣返流情况加重较 GP 组高（P ＝0．038），同时单纯组心房扩大也较 GP 组明显（P ＝0．04）。结论RFMM Ⅲ术＋心脏 GP 消融术治疗合并风湿性二尖瓣病变心房纤颤疗效优于既往单纯 RFMM Ⅲ术，有效转复律及窦律维持率高且复发率低，能有效改善二尖瓣置换术后患者三尖瓣返流情况，有利于远期预后。
목적：비교직시하사빈소융개량미궁Ⅲ술（RFMM Ⅲ）＋심장신경절총（GP）소융술여단순 RFMM Ⅲ술치료합병풍습성이첨판병변적심방섬전료효。방법회고성분석인풍습성이첨판병변합병심방섬전접수 RFMM Ⅲ술＋심장 GP 소융술100례（GP 조）급동기행단순 RFMM Ⅲ술100례（단순조）환자적자료，대량조환자위수술기여1、6、12개월수방기내적각항림상지표진행비교분석。결과술후1、6、12개월적수방중，GP 조두성심률자균고우단순조（P 의차위0．03、0．02급0．03）。술후12개월수방결과현시단순조삼첨판반류정황가중교 GP 조고（P ＝0．038），동시단순조심방확대야교 GP 조명현（P ＝0．04）。결론RFMM Ⅲ술＋심장 GP 소융술치료합병풍습성이첨판병변심방섬전료효우우기왕단순 RFMM Ⅲ술，유효전복률급두률유지솔고차복발솔저，능유효개선이첨판치환술후환자삼첨판반류정황，유리우원기예후。
Objective To compare the efficacy and safety of radiofrequency modified maze Ⅲ (RFMM Ⅲ)plus gan-glionic plexus (GP)ablation with RFMM Ⅲ alone in the treatment of atrial fibrillation with rheumatic mitral lesion. Methods A retrospective analysis was performed to analyze the clinical data of 200 patients who underwent RFMM Ⅲplus GP ablation (n =100,GP group)or RFMM Ⅲ alone (n =100,solo group)in the treatment of atrial fibrillation with rheumatic mitral lesion.Results The sinus rhythm maintenance rate in the GP group was higher than that of the solo group 1,6 and 12 months after operation (P =0.03,0.02 and 0.03,respectively).The solo group showed a higher incidence of aggravating tricuspid regurgitation and more obvious left atria enlargement than the GP group 12 months after operation (P =0.03).Conclusion RFMM Ⅲ plus GP ablation,with higher sinus rhythm maintenancerate and lower recurrence rate,might be superior to RFMM Ⅲ alone in the treatment of atrial fibrillation with rheumatic mitral lesion,which might effectively improve tricuspid regurgitation in patients undergoing mitral valve replacement and be beneficial for their long-term prognosis.