全胸腔镜下二尖瓣置换同期行射频消融术的临床研究

Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery

目的探讨全胸腔镜下二尖瓣置换同期行射频消融术的可行性、安全性和有效性。方法回顾性分析2014年1月至2018年10月于我院行二尖瓣置换同期行射频消融术的107例风湿性二尖瓣病变合并心房颤动患者的临床资料,根据手术方式不同分为全胸腔镜组[n=51,其中男20例、女31例,平均年龄(50.57±5.24)岁]和正中开胸组[n=56,其中男21例、女35例,平均年龄(52.12±5.59)岁]。比较两组患者术前、术中及术后情况。结果所有患者均成功完成手术,无死亡病例。在术中出血量、引流量、呼吸机辅助时间、住院时间及手术切口长度方面,全胸腔镜组优于正中开胸组,差异有统计学意义(P<0.05);全胸腔镜组体外循环时间和射频消融时间长于正中开胸组,差异有统计学意义(P<0.05);两组患者在手术时间、主动脉阻断时间、术后并发症、术后左心室射血分数、术后左心房内径、窦性心律维持情况等方面差异无统计学意义(P>0.05)。两组患者术后随访均未见房室传导阻滞、肺静脉狭窄、心房食管瘘、冠状动脉损伤、脑卒中、出血等事件发生。结论全胸腔镜下二尖瓣置换同期行射频消融术安全、有效,具有临床应用价值。

Objective To investigate the feasibility,safety and effectiveness of radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery.Methods The clinical data of 107 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time in our hospital from January 2014 to October 2018 were retrospectively analyzed.The patients were divided into two groups:a totally thoracoscopic surgery group(n=51,including 20 males and 31 females,aged 50.57±5.24 years)and a median sternotomy group(n=56,including 21 males and 35 females,aged 52.12±5.59 years)according to the surgical methods.The preoperative,intraoperative and postoperative data of the patients were compared.Results All operations were successfully completed without death.In terms of bleeding volume,drainage volume,ventilator-assisted breathing time,hospital stay and incision length,the totally thoracoscopic surgery group was better than the median sternotomy group,and the difference was statistically significant(P<0.05).The cardiopulmonary bypass time and radiofrequency ablation time in the totally thoracoscopic surgery group were longer than those in the median sternotomy group(P<0.05).There was no significant difference in the operation time,aortic occlusion time,postoperative complications,left ventricular ejection fraction,left atrial diameter and sinus rhythm maintenance between the two groups(P>0.05).There was no atrioventricular block,pulmonary vein stenosis,atrioesophageal fistula,coronary artery injury,stroke or hemorrhage during the follow-up.Conclusion Radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery is safe and effective,and it is worthy of clinical application.