冠心病合并左心室室壁瘤的手术治疗分析

Surgical Treatment of Coronary Heart Disease Combined with Left Ventricular Aneurysm

目的:分析和探讨冠心病合并室壁瘤的外科手术治疗的方法。方法:2008年1月至2014年3月我科共收治37例冠心病合并左心室室壁瘤患者,均在体外循环下行冠脉搭桥术,室壁瘤直径小于50 mm采用"三明治"法室壁瘤折叠术(13例),室壁瘤直径大于50 mm采用Dor标准术式(24例);同期行二尖瓣置换术5例,二尖瓣成形术3例,三尖瓣成形术4例,主动脉瓣置换术3例。比较术前、术后2周及术后一年患者左心室舒张末期内径、左室射血分数、NYHA心功能分级,评价手术治疗效果。结果:所有病例均手术成功,前降支均采用左乳内动脉作为桥血管,移植血管1-4支。术后1例因肺部感染死亡,1例猝死,其余均康复出院。术后血胸再次开胸止血1例。随访34例,1例失访。术后2周、术后1年患者左室射血分数(LVEF)(44.27±7.22)%、(49.32±6.98)%较术前(34.47±8.13)%明显改善,左室舒张末期直径(LVEDD)(51.87±6.25)mm、(50.73±5.72)mm)较术前(61.25±5.21)mm明显改善,心功能分级(1.82±0.47)、(1.64±0.51)较术前(3.08±0.55)明显改善,上述差异均有统计学意义(P<0.05)。结论:对冠心病合并室壁瘤患者,根据瘤体大小及部位选择不同手术方式,并同期冠脉搭桥及矫治瓣膜功能障碍,临床疗效满意。

Objective：To analyze and investigate the methods of surgical treatment for coronary heart disease（CHD） combined with left ventricular aneurysm.Methods：The clinical data of 37 patients with CHD combined with left ventricular aneurysm were retrospectively analyzed.All of the patients were treated with coronary artery bypass graft under cardiopulmonary bypass.The concomitant procedures included 13 cases of improved placation,24 cases of Dor procedure,5cases of mitral valve replacement,3 cases of mitral valvuloplasty,4 cases of tricuspid valvuloplasty,3 cases of aortic valve replacement.The left ventricular end-diastolic dimension（LVEDD）,left ventricular ejection fraction（LVEF） and NYHA heart function classification were compared in all patients before operation,2 weeks after operation and 1 year after operation to evaluate the effect of surgical treatment.Results：All the 37 patients were successfully operated,and the numbers of graft applied ranged from 1 to 4.2 patients died after operation due to the pulmonary infection or sudden death.One patient underwent re-thoracotomy exploration because of postoperative hemothorax.LVEF was significantly higher 2 weeks after operation（44.27±7.22） % and 1 year after operation（49.32±6.98） %） than that before operation（34.47 ±8.13） %（P0.05）.LVEDD was significantly shorter 2 weeks after operation（51.87 ±6.25）mm and 1 year after operation（50.73±5.72）mm than that before operation（61.25±5.21）mm（P0.05）.NYHA was significantly higher 2 weeks after operation（1.82±0.47） and 1 year after operation（1.64±0.51） than that before operation（3.08±0.55）（P0.05）.Conclusions：In the treatment of CHD combined with left ventricular aneurysm,the different surgical management should be selected according to the position and diameter of left ventricular aneurysm.Concomitant revascularization and valve repair can gain a fine clinical curative effects.