大Box肺静脉隔离技术在外科房颤射频消融治疗中的应用

Application of cardiac surgery concomitant with Cox maze IV procedure modified with big box line to isolate pulmonary veins for the patients with heart disease and atrial fibrillation

目的总结针对左房消融线路进行改良的大Box肺静脉隔离技术的Cox迷宫Ⅳ手术对器质性心脏病合并心房纤颤的同期外科治疗效果。方法我院心血管外科因器质性心脏病变合并心房纤颤患者192例，在接受心脏直视术同时行双极射频Cox迷宫Ⅳ手术，随机分为大Box组和传统组，前者在行左房消融时进行线路改良采用大Box法行肺静脉隔离，后者采用传统方法操作。两组患者年龄、男女比例、房颤病程、左房内径、同期进行的其他心脏手术等资料比较差异无统计学意义（P〉0．05）。结果两组均无死亡病例。传统组再次开胸止血2例，大Box组再次开胸止血1例，两组切口感染各1例。术后临时心脏起搏器使用时间大Box组显著长于传统组（P〈0．05），术后当天房颤消除率大Box组优于传统组（P〈0．05）；出院时和术后1个月大Box组房颤消除率均高于传统组（P〈0．05），随访3个月和12个月时两组间窦性或房性心律维持率差异无统计学意义（P〉0．05）；传统组内比较，12个月时窦性或房性心律维持率明显高于随访1个月时（P〈0．05）；两组升主动脉阻断时间、射频消融时间、体外循环时间、重症监护室（ICU）时间等差异无统计学意义（P〉0．05）。结论合并器质性心脏病的心房纤颤在行直视心脏手术同时，应该把改良Cox迷宫手术作为标准治疗，大Box肺静脉隔离技术相对于传统的消融线，简化了操作，透壁效果更佳。

Objective To evaluate the efficacy of cardiac surgery concomitant with Cox Maze Ⅳ procedure modified with big box line to isolate pulmonary veins for the patients with heart disease and atrial fibrillation （AF）. Methods From January 2013 to June 2015, 192 organic - heart - disease patients com- bined with AF were divided into 2 groups randomly in our hospital. Pulmonary veins were isolated with a modified big box ablation line in big -box group, and a conventional line was done in conventional group. There was no significant difference in the age, gender, AF duration and inner diameter of left atrium （LA） between the two groups. Results There was no in - hospital death. There were 2 cases of re - thoracotomy for hemostasis in conventional group, and 1 in big - box group, and 1 incision infection each, respectively. Postoperatively, time of temporary pacing in big - box group was longer significantly than that in conven- tional group （ P 〈 0. 05 ）. The rate of conversion to sinus rhythm （SR） or functional rhythm was signifi- cantly higher in big - box group than in conventional （ P 〈 0. 05 ） on the operative day, and there was the same trendency on the discharge day （ P 〈 0. 05 ） and 1 - month follow - up （ P 〈 0.05 ）. There was no sig- nificant difference between two groups on 3 - month （ P 〉 0. 05 ） and 12 - month （ P 〉 0. 05 ） follow - up. In conventional group, the rate of conversion to SR or functional rhythm was significantly higher on 12 - month follow - up than on 1 - month follow - up. There was no significant difference between the two groups in the time of the aortic cross - clamping （ P 〉 0. 05 ）, radiofrequency ablation （ P 〉 0. 05 ）, extracorporeal circulation （ P 〉 0. 05 ） and staying in intensive care unit （ ICU,P 〉 0. 05 ）. Conclusion The efficacy of cardiacsurgery concomitant with Cox Maze IVproeedurc is satisfied, and the procedure should be reeommencied as standard treatment. The big box line modifies the ablation of left vehtricular, simplizes the procedure and is more beneficial to orgonic - heart - disease patients combined with AF.