全胸腔镜左心房后入路射频迷宫手术治疗32例孤立性心房纤颤

Totally thoracoscopic surgery for isolated atrial fibrillation

目的探讨全胸腔镜下左心房后人路射频迷宫手术治疗孤立性心房纤颤的实用性及安全性。方法2010年2月至2011年11月，采用全胸腔镜下左心房后入路射频迷宫手术治疗孤立性心房纤颤（房颤）患者32例，其中阵发性21例，持续性11例。左后胸壁3个胸腔镜套管切口入胸，完全胸腔镜下视野，肺门后、食管前、左心房后切开心包，暴露左心房，行左心房迷宫射频消融、左心耳切除手术。结果全组无手术死亡及严重手术并发症，1例因右肺上静脉出血中转开胸手术。手术时间87～238min，术后住院期间10例出现阵发性房颤，出院时均为窦性心律。均出院，随访4～20个月，31例为窦性心律，1例持续性房颤患者出现阵发性房扑。结论胸腔镜左心房后入路左心房暴露好，可行左心房射频消融、左心耳切除手术，效果好、创伤小。

Objective This paper reported our experience with thoracoscopic management of isolated atrial fibrillation to define the efficacy and safety of this approach. Methods Thirtytwo patients （ 17 mem, 15 women） with isolated atrial fibrillation underwent thoracoscopic surgery. All procedures were finished under 3 port incisions on left posterior chest. Among them 18 cases are paroxysmal and 8 persistent. Results There was no operative death or major perioperative complications. One ease was converted to limited thoracotomy because of bleeding. Operation time was 87 -238 min. Paroxysmal atrial fibrillation occurred in 9 cases in hospital and all the cases were sinus rhythm after discharge. Followup 4 to 20 months, One persistent case was converted paroxysmal. Conclusion Patients with isolated atrial fibrillation can benefited by Videoassisted thoracoscopic left posterior approach with better exposure of left atrial and resection of the left atrial appendage, with decreased opera- tive trauma and better results.