胸腔镜辅助下的肺静脉微创隔离消融术治疗心房颤动

Thoracoscopy video assisted minimally invasive bilateral pulmonary vein isolation for treatment of atrial fibrillation

目的介绍20例微创外科手术治疗心房颤动（房颤）的经验，探讨微创外科治疗房颤的可行性及安全性，促进心脏外科在房颤治疗领域新技术的引进及开展。方法自2006年12月至2007年4月，对20例房颤患者施行了胸腔镜辅助下非体外心表双侧肺静脉隔离术。病例包括抗心律失常药物治疗无效或不能耐受药物及导管消融术后复发的患者。手术切口包括每侧胸壁各2个1cm腔镜及器械入口，1个5cm手术操作切口。主要步骤为肺静脉射频消融隔离及左心耳切除。手术中使用了WOLF分离器和ATRICURE双极射频消融夹，EZ45G软组织切割缝合器。结果手术过程顺利。手术时间（130±25）min，平均术中失血量50ml。无手术死亡。平均住院天数（8．0±3．8）d。术后随访至6个月，无死亡及脑卒中发生。术后随访窦性心律转复率：满3个月随访12例，其中10例为窦性心律（83．3％）；满6个月随访3例，均为窦性心律。结论手术病例证明了微创外科手术治疗房颤的可行性、安全性及有效性。同介入式及外科正中切口房颤治疗方法相比，该术式具有经济、简单、创伤小及肺静脉隔离确切等特点，是一项创伤小、有发展潜力的房颤治疗新技术。

Objective This study is to evaluate the feasibility and safety of thoracoscopy video assisted minimally invasive bilateral pulmonary vein isolation for treatment of atrial fibrillation. Methods From December 2006 to April 2007, thorascopy video assisted off-pump epicardial pulmonary vein isolation was performed in 20 patients with atrial fibrillation. All patients were either refractory or intolerant to antiarrhythmic drug therapy or already experienced unsuccessful catheter-based ablation. The procedure includes 21 cm ports for the thoracoscopic camera and ablation device, and a 5 cm working port on each side of the chest wall. Bilaterally pulmonary vine were isolated by using an Atricure^TM bipolar radiofrequency device. LAA was removed by using a Johnson ＆ Johnson EZ45G stapler. Intraoperative pacing and sensing was used to confirm bidirectional block of the ablation lines. Results The procedure was successful in all patients. Nineteen patients were in sinus rhythm immediately after the surgery and 1 patient was still in AF rhythm post surgery and converted to sinus rhythm by electrical conversion in the operation room. One patient was reintubated because of low SaO2 and 1 patient received IABP for LV failure. Mean operation time was （130±25 ）min and average hospital stay was （8.0±3.8）d.3-months follow up was finished in 12 patients at after the surgery and 10 patients were free of AF （ 10/12, 83.3% ）, 6-months follow up was finished in 3 patients and all in sinus rhythm （3/3, 100% ）. Conclusion Our results suggested that thoracoscopy video assisted minimally invasive bilateral pulmonary vein isolation is a safe, feasible and effective technique for treatment of atrial fibrillation.