室壁瘤切除左室成形的临床经验..doc

室壁瘤切除左室成形的临床经验 作者：高长青,李伯君,肖苍松 作者单位：中国人民解放军总医院心血管外科，全军心脏外科研究所，北京 100853 【摘要】 目的探讨室壁瘤切除并左室成形术的手术经验。 方法1998年至2006年，共58例患者行室壁瘤切除并左室成形术，包括Jatene术式12例、Dor术式44例及Cooley术式2例，均同期行冠脉搭桥术。所有患者术前及术后均行超声心动图（经胸壁和/或经食道超声心动图），记录左室射血分数、左室收缩及舒张末期容积和左室收缩及舒张末期容积指数等指标。结果所有患者无死亡。超声心动图显示，与术前相比，所有患者的左室收缩及舒张末期容积均显著降低、左室射血分数则显著升高，尤其是后10例患者的射血分数增加更为明显。远期随访发现，2例患者心功能恶化，其余患者心功能状况良好，无死亡病例。结论对于心肌缺血导致的慢性心力衰竭，外科手术行左室减容和几何成形、同期行冠脉搭桥是一种积极有效的治疗措施。术后左室收缩末容积指数是判断近、远期疗效的关键指标。 【关键词】 心脏；室壁瘤；缺血性心肌病；左室成形；外科手术；超声心动图 基金项目： 军队十五面上项目（01MA100） 　　The Clinical Experience of Surgical Ventricular Restoration for Left Ventricular Aneurysm 　　GAO Chang-qing, LI Bo-jun, XIAO Cang-song, JIANG Sheng-li, WU Yang, ZHU Lang-biao, MA Xiao-hui, LIU Guo-peng, SHENG Wei, YANG Ming, WANG Gang, WANG Yao, CHEN Ting-ting, ZHOU Qi, ZHANG Tao, LI Jia-chun, WANG Jia-li, DING Zhen-yuan, LUO Jin 　　Department of Cardiovascular Surgery of PLA General Hospital, PLA Institute of Cardiac Surgery, Beijing 100853, China 　　Abstract: OBJECTIVE To summarize the operative experience of left ventricular aneurysm (LVA) in PLA general hospital.METHODSSince 1998, total 58 patients were underwent LVA operation, including 12 cases using Jatenes technique, 44 Dors and 2 Cooleys, and all patients were underwent coronary artery bypass grafts (CABG) simultaneously. Echocardiograms (transthoracic echocardiography and/or transesophageal echocardiography) were used to all cases before and after operations, and the left ventricle ejection fraction (LVEF), left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricle end-diastolic volume index (LVEDVI) and left ventricle end-systolic volume index (LVESVI) were recorded.RESULTSNo patient died during hospital stay. The echocardiography showed that all patients LVEDV, LVESV, LVEDVI and LVESVI were significantly decreased postoperatively (P0.05), the LVEF were increased significantly (P0.05), especialy for the recent 10 cases. Follow-up f