心肌切断联合撕开法治疗心肌桥的临床疗效

The clinical outcomes of myocardial incision and tearing for the treatment of myocardial bridge

目的探讨心肌切断联合撕开法治疗心肌桥的临床疗效。方法回顾性收集2014年1月至2018年1月期间29例行肌桥松解术治疗冠状动脉心肌桥患者的临床资料。其中男17例,女12例;年龄33~75岁,平均(56.02±14.44)岁。按照手术方法将患者分为切开组(11例)和撕开组(18例)。切开组行传统肌桥松解法,用小圆刀沿冠状动脉走行方向纵行切开肌桥。撕开组行心肌切断联合撕开法,纵行切开肌桥浅部,联合深部组织撕开。对比两组手术时间、术中出血量、分支血管损伤和术中心室破裂情况。术后门诊随访0.5~1.0年,观察术后心绞痛临床症状、心肌缺血表现和冠状动脉狭窄情况。结果与撕开组比较,切开组行心肌桥松解手术时间明显延长,出血量多,分支血管损伤患者比例大,差异均有统计学意义(P<0.05)。两组术中心室破裂患者比例差异无统计学意义(P>0.05)。术后随访期间,两组在心绞痛症状、复发心肌桥和心肌缺血患者比例方面差异均无统计学意义(P>0.05)。结论相较于传统纵行切开肌桥的手术方式,心肌切断联合撕开法治疗心肌桥手术时间短、出血量少,值得临床推广。

Objective To analyze clinical outcomes of myocardial incision and tearing for the treatment of myocardial bridge.Methods A retrospective cohort study was conduct to review the clinical date of 29 patients who underwent surgical myotomy from January 2014 to January 2018 in the Second Hospital of Lanzhou University.A total of 11 patients(incision group)were experienced traditional myotomy on myocardial bridge that the myocardium was longitudinally incised along the direction of the coronary artery,while 18 patients(tearing group)were treated by myocardial incision combined with tearing that longitudinally incised myocardium and deeply tissue tearing.The operation time of surgical myotomy,the amount of bleeding,the number of branches of vascular injury and the number of ventricular ruptures during operation were compared between the two groups.After followed up half a year to one year,the clinical symptoms of angina pectoris,myocardial ischemia by electrocardiogram suggested,and coronary stenosis by coronary CT suggested were collected.Results The operation time of surgical myotomy,the amount of bleeding patients and the number of branches of vascular injury during operation in the incision group were higher than those in the tearing group(P<0.05).There was no significant difference for the number of ventricular ruptures during operation(P>0.05).After followed up half a year to one year,there was no significant difference in the clinical symptoms of angina pectoris,myocardial ischemia by electrocardiogram suggested,and coronary stenosis by coronary CT suggested(P>0.05).Conclusion Myocardial incision combined with tearing is a surgical procedure with short operation time and low bleeding risk,which is more beneficial than the traditional longitudinally incised for the myocardial bridge.