缩窄性心包炎32例的外科治疗

Surgical treatment for 32 patients with constrictive pericarditis

目的总结32例缩窄性心包炎患者的外科治疗经验。方法回顾性分析2004年1月至2013年2月在东莞市人民医院接受外科手术治疗的32例缩窄性心包炎患者的临床资料。结果本组患者13例（40.6%）经左胸前外侧径路行心包部分剥脱,19例（59.4%）经胸前正中径路行完全心包剥脱,手术无死亡,术中均证实缩窄性心包炎诊断,病理检查提示心包结核样病变22例（68.8%）,术后并发低心排血量综合征3例（9.4%）,经强心、利尿等治疗后明显改善。32例患者出院时纽约心脏协会心功能均在Ⅰ~Ⅱ级,肘正中静脉压较术前降低[术前（31.3±4.8）cm H2O vs.术后（12.1±3.8）cm H2O,P〈0.05;1 cm H2O=0.098 k Pa）。随访28例（87.5%）患者1年无复发,心功能稳定。结论结核仍是缩窄性心包炎的主要病因,心包剥脱是缩窄性心包炎的有效治疗手段,针对具体病情选择合适的手术方式更有利于患者术后恢复。

Objectives To summarize the experience of surgical treatment for constrictive pericarditis and to explore the factors influencing surgical outcomes. Methods Clinical details of 32 patients with constrictive pericarditis undergoing pericardiectomy between January 2004 and February 2013 in Dongguan People ＇s Hospital were restropectively analyzed.Results There were 19 patients（59.4%） undergoing total pericardiectomy by midline sternotomy and 13 patients（40.6%） undergoing partial pericardiectomy through left anterolateral thoracotomy. There was no perioperative mortality.Constrictive pericarditis was caused by tuberculosis in 22 cases（68.8%）. One week postoperatively, the pressure of median cubital vein declined to normal in 32 patients with New York Heart Association（NYHA） functional class I-II[preoperative（31.3 ±4.8） cm H2 O vs. postoperative（12.1 ±3.8） cm H2 O, P〈0.05; 1 cm H2 O =0.098 k Pa ]. Three patients（9.4%） complicated with low cardiac output syndrome postoperatively and recovered when discharged. Twentyeight available patients（87.5%） had been followed up for one year postoperatively and they were all in NYHA functional class I-II. Conclusions Tuberculosis remains an important cause of constrictive pericarditis. It is crucial for patients with constrictive pericarditis to be confirmed as soon as possible with active surgical treatment to reduce mortality and morbidity. The specific pericardiectomy should be decided according to the individual conditions.