室壁瘤切除左室成形的临床经验.docVIP

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，姜胜利，吴扬，朱朗标，马晓辉， 刘国鹏，盛炜， 杨明，王刚，王瑶，周琪，张涛，李佳春，王加利，丁振元，骆荩，陈婷婷 【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 　　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 Jatene’s technique, 44 Dor’s and 2 Cooley’s, 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 found that cardiac function has improved for all patients except 2.CONCLUSION Surgical ventricular restoration combined with CABG, is an effective management for chronic heart failure induced by ischemic myocardial disease. 　　Key words：Heart;Left ventricular aneurysm;Ischemic myocardial disease;Surgical ventricular restoration;Operation; Echocardiography 　　心肌缺血导致的慢性心力衰竭的治疗是公认的世界性难题。心肌梗死后形成室壁瘤，或进一步 发展 至缺血性心肌病，并发二尖瓣关闭不全，心肌收缩和舒张功能严重受损，导致慢性心力衰竭。众多 研究 表明，心脏收缩功能很差、心脏显著扩大的缺血性心肌病患者，单纯药物治疗2年内约