胸腔镜下单纯肺静脉隔离手术与左心房盒式消融术治疗孤立性房颤的临床价值比较

Comparison of clinical value of thoracoscopic simple pulmonary vein isolation surgery and left atrial ablation for isolated atrial fibrillation

目的比较胸腔镜下单纯肺静脉隔离术(PVI)与左心房盒式消融术(Box)治疗孤立性房颤的临床价值。方法采用回顾性研究方法,选取2016年1月至2018年8月湖北省中医院收治的孤立性房颤患者80例,根据手术方法不同将患者分为PVI组和Box组,每组各40例。PVI组患者采用胸腔镜下单纯PVI术治疗,Box组患者采用双极射频消融钳完成Box术治疗。比较两组患者的术后和出院时的窦性心率转复率、早期与晚期复发率以及末次随访结果。结果术后随访1.0~2.7年,平均(1.84±0.57)年,两组随访有效率均为100%。Box组患者的术后与出院时窦性心律转复率(82.5%,72.5%)明显高于PVI组(67.5%,57.5%),差异具有统计学意义(P<0.05)。Box组患者早期复发率(12.5%)明显低于PVI组(25.0%),差异具有统计学意义(P<0.05)。Box组患者晚期复发率(7.5%)低于PVI组(17.5%),但差异无显著性(P>0.05)。末次随访结果显示,Box组患者窦性心率比率(82.5%)明显高于对PVI组(62.5%),房颤以及房扑心率比率(15.0%)明显低于PVI组(27.5%),差异具有统计学意义(P<0.05)。结论胸腔镜下Box术可有效提高孤立性房颤患者窦性心律转复率、降低早期复发率,具有较高的临床价值。

Objective To compare the clinical value of thoracoscopic simple pulmonary vein isolation(PVI)and Left atrial box ablation(Box)in the treatment of isolated atrial fibrillation.Methods A retrospective study was conducted to select 80 patients with isolated atrial fibrillation admitted to the Hubei Provincial Hospital of Traditional Chinese Medicine from January 2016 to August 2018.Patients were divided into PVI group and Box group according to different surgical methods,40 cases in each group.Patients in the PVI group were treated with thoracoscopic PVI alone,and the Box group was treated with bipolar radiofrequency ablation forceps.The sinus rhythm conversion rate,post-early and late recurrence rate,and the final follow-up results were compared between the two groups.Results The patients were followed up for 1 to 2.7 years,with an average of(1.84±0.57)years.The follow-up efficiency was 100%.The sinus rhythm conversion rate(82.5%,72.5%)was significantly higher in the Box group than in the PVI group(67.5%,57.5%),and the difference was statistically significant(P<0.05).The early recurrence rate of the Box group(12.5%)was significantly lower than that of the PVI group(25.0%),and the difference was statistically significant(P<0.05).The late recurrence rate(7.5%)was lower in the Box group than in the PVI group(17.5%),but the difference was not significant(P>0.05).The final follow-up results showed that the sinus heart rate ratio(82.5%)was significantly higher in the Box group than in the PVI group(62.5%),and the atrial fibrillation and atrial flutter heart rate ratio(15.0%)was lower than the PVI group(27.5%)(P<0.05).Conclusion Thoracoscopic Box surgery can effectively improve the sinus rhythm conversion rate and reduce the early recurrence rate,and has a high clinical value.