心耳夹和切割闭合器在胸腔镜心房颤动治疗中对左心耳处理的疗效比较

Efficacy of clips versus staplers for left atrial appendage in the thoracoscopic treatment of atrial fibrillation

目的总结心耳夹和切割闭合器在胸腔镜心房颤动(房颤)治疗中对左心耳处理的疗效。方法回顾性分析2015—2016年上海交通大学医学院附属新华医院收治的房颤患者的临床资料。所有患者均行梅氏微创房颤手术治疗。将术中采用心耳夹夹闭左心耳的患者纳入心耳夹组,术中用切割闭合器切除左心耳的患者纳入切割闭合器组。随访采用门诊复诊和电话等方式。通过患者自觉症状及心电图、24 h动态心电图等检查,记录患者术后心律情况。术后随访期间至少复查1次头颅磁共振成像、心脏CT和超声心动图。结果60例患者纳入研究。心耳夹组30例,其中男20例、女10例,平均年龄(65.7±7.1)岁;切割闭合器组30例,其中男20例、女10例,平均年龄(66.8±5.4)岁。全部患者顺利完成手术,无中转开胸手术,围手术期无死亡。56例(93.3%)出院时维持窦性心律。术后59例患者保持随访,心耳夹组1例患者失访。随访截至2020年6月,随访时间42~66(54.1±7.3)个月。心耳夹组左心耳残留长度为(3.9±1.8)mm,切割闭合器组为(3.9±2.8)mm,两组差异无统计学意义(P=0.910)。生存曲线分析左心耳切除或夹闭对窦性心律维持的差异无统计学意义(P=0.757)。随访期间所有患者无卒中等脑血管不良事件。结论胸腔镜房颤手术中夹闭或切除左心耳都是安全、有效的方法,都可有效预防卒中。心耳夹让微创外科干预左心耳更加安全和方便。

Objective To summarize the efficacy of clips and staplers for left atrial appendage in the thoracoscopic treatment of atrial fibrillation.Methods The clinical data of patients with atrial fibrillation treated in Xinhua Hospital from 2015 to 2016 were retrospectively analyzed.All patients received Mei's minimally invasive surgery for atrial fibrillation.Among them,patients were recruited in a clip group by clipping the left atrial appendage.The other patients were recruited in a stapler group to resect the left atrial appendage by stapler.Follow-up was conducted by outpatient clinic and telephone.Postoperative heart rhythm was recorded by the patient's symptoms,electrocardiogram and 24 h holter.Cranial magnetic resonance,cardiac CT and echocardiography were performed at least once during follow-up.Results There were 30 patients in the clip group,including 20 males and 10 females,with an average age of 65.7±7.1 years.There were 30 patients in the stapler group,including 20 males and 10 females with an average age of 66.8±5.4 years.All patients successfully received the procedure,with no conversion to thoracotomy or perioperative death.Sinus rhythm was maintained at discharge in 56(93.3%)patients.Till June 2020,59 patients were followed up for 42-66(54.1±7.3)months and 1 patient in the clip group was lost.The residual length of the left atrial appendage was 3.9±1.8 mm in the clip group and 3.9±2.8 mm in the stapler group,and there was no statistical difference between the two groups(P=0.910).Kaplan-Meier curve indicated that there was no statistical difference in the maintenance of sinus rhythm between the two groups(P=0.757).During the follow-up period,all patients had no cerebrovascular adverse events such as stroke or embolism.Conclusion Clipping and resection of the left atrial appendage in thoracoscopic atrial fibrillation surgery are both safe and effective methods,which effectively prevent stroke.The atrial appendage clip makes the minimally invasive surgical intervention of the left atrial appendage safer and more convenient.