左心室假性室壁瘤的外科治疗

Surgical treatment of left ventricular pseudoaneurysm

目的分析左心室假性室壁瘤的外科治疗方法及随访结果，以提高其临床治疗效果。方法回顾性分析2014年1月至2016年12月阜外医院收治的5例左一t2,室假性室壁瘤患者的临床资料，其中男性3例、女性2例，平均年龄26~64（51．4±14．9）岁。瘤颈平均（25．3±15．8）mm，假性室壁瘤直径大小为（70．4±39．9）mm。LVEF30％~60％（48．24±13.3）％。4例行假性室壁瘤手术，1例患者经胸左侧第五肋间前外侧切口行封堵伞封堵术。同期行冠状动脉旁路移植手术3例，合并二尖瓣成形术1例，三尖瓣成形术1例。对所有出院患者进行随访。结果5例手术后全部存活，顺利出院。术后平均住院天数（10．2±3．7）d，体外循环时间（149．3±55．6）min，主动脉阻断时间（95．5±55．6）min，术后呼吸机使用时间（31．5±21．0）h。无气管切开等并发症发生。平均随访时间为（1．7±0．7）年，患者均可以正常生活。结论假性室壁瘤病情凶险，一经诊断明确，积极准备手术，根据患者病情、假性室壁瘤形成时间、瘤颈大小、瘤体大小和部位，采用不同的手术方法。对于外科手术极高危的患者可以采用介入封堵或小切口介入封堵的方法。

Objective To analysis of treatment of left ventricular pseudoaneurysm and follow-up results in the past 3 years. Methods Between January 2014 to December 2016, 5 patients（3 males and 2 females）. The av- erage age was 26-64 （51.4±14.9 ）years, were treated with surgical repair of left ventricular pseudoaneurysm in Fu- wai Hospital. pseudoaneurysm neck： average （25.3 ± 15.8 ） ram, pseudo aneurysm diameter was （ 70.4± 39.9 ） mm. LVEF 30%-60% （48.2±13.3）%. 4 cases of surgical treatment of ventricular aneurysm surgery. Occlusion was per- formed in 1 patient through left anterolateral fifth intercostal space. Coronary artery bypass grafting was performed in 3 cases, 1 cases underwent mitral valvuloplasty, and tricuspid valvuloplasty in 1 cases. All discharged patients were followed up. Results All 5 patients survived and discharged. The average postoperative hospital stay was （10.2±3.7） days. The mean cardiopulmonary bypass time was （149.3±55.6）min, mean aortic cross-clamping time was （95.5±55,6）min, and mean postoperative ventilation time was （31.5±21.0）h. No complications such as tra- cheotomy occurred. The mean follow-up time was （1.7±0.7）years. No patient required re-operation. Conclusion Pseudoaneurysm remains a challenging heart disease. According to patient＇s condition, pseudoaneurysm formation time, aneurysm neck size, tumor size and location, using different surgical methods. For patients with extremely high risk of conventional surgery, interventional occlusion or small incision interventional occlusion can be used.