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目的总结胸腔镜辅助下微创外科射频消融治疗单纯性心房颤动的经验和疗效。方法 2009年1月至2010年12月对6例单纯性房颤患者施行胸腔镜辅助下微创房颤射频消融手术,6例均为男性,平均年龄56.8岁,3例术前吸烟,2例合并高血压病,均为阵发性房颤,未接受过导管消融治疗。术前经食道超声证实无左房血栓,术前左房直径平均41.67mm。所有患者均在胸腔镜辅助下行双侧肺静脉前庭隔离、Marshall韧带切断、左心耳切除,但均未行心外膜标测,3例行肋间神经注射止痛。结果本组患者平均手术时间233min,均手术顺利,术后平均住院日9d,无围术期死亡。出院时窦性心律比例为50.0%(3/6),随访时间17～39个月,随访时窦性心律比例为83.3%(5/6)。随访期间无血栓及栓塞事件发生。结论胸腔镜辅助微创外科射频消融治疗单纯性心房颤动创伤小、恢复快、安全性高,中期疗效理想。
Objective To summarize the experience and curative effect of minimally invasive surgical radiofrequency ablation assisted with thoracoscope in the treatment of simple atrial fibrillation. Methods From January 2009 to December 2010, 6 patients with simple atrial fibrillation underwent thoracoscopic assisted minimally invasive atrial fibrillation radiofrequency catheter ablation. All 6 patients were male, mean age 56.8 years, 3 preoperative smoking, 2 patients Hypertension with paroxysmal atrial fibrillation, have not received catheter ablation. Preoperative trans-esophageal ultrasound confirmed no left atrial thrombi, preoperative left atrial diameter average 41.67mm. All patients underwent thoracoscopic assisted bilateral veins vestibular separation of the bilateral pulmonary veins, Marshall ligament cut, left atrial appendage resection, but no epicardial mapping, 3 cases of intercostal nerve injection analgesia. Results The mean operative time of this group was 233 min, both were successful and the average postoperative hospital stay was 9 days without perioperative death. The percentage of sinus rhythm at discharge was 50.0% (3/6) and the follow-up time was 17-39 months. The rate of sinus rhythm at follow-up was 83.3% (5/6). No thrombosis and embolic events occurred during follow-up. Conclusions Thoracoscope-assisted minimally invasive surgical radiofrequency ablation is superior in traumatic injury, recovery and safety of simple atrial fibrillation.