改良单房迷宫手术的临床研究.DOC

冷冻消融简化左房迷宫术的实验研究 赵曙光，范世豪，崔光浩（200235上海，远大心胸医院成人心脏外科中心） [摘要] 目的：探讨应用冷冻消融行简化左房迷宫术能否造成房壁的透壁损伤，并导致急性及慢性的肺静脉电隔离效应。方法：35-45kg的家猪16只，在体外循环下采用冷冻消融钳完成简化左房迷宫术。术中及术后30天采用单极起搏器测试肺静脉电隔离效果，并于术后30min及30d取冷冻消融组织行病理检查。结果：应用冷冻消融钳能够完成简化左房迷宫术，术后所有实验动物均产生肺静脉电隔离效应，组织病理检查显示小于5mm厚的组织100%发生透壁损伤，大于 [关键词]心房颤动；迷宫手术; 冷冻消融 [中图法分类号] R615 [文献标志码]A The experimental research of simplified left maze cryoablation procedure ZHAO Shu-guang, FAN Shi-hao, CUI Guang-hao (yodak cardiothoracic hospital, Adult cardiacsurgery departerment,Shanghai 200235,China) [Abstract] Objective: To evaluate simplified left atrial cryoablation maze procedure can cause tissue damage through the wall and lead to acute and chronic effects of pulmonary vein isolation. Methods : 16 pigs, 35-45 kg, which received simplified left atrial cryoablation maze in the Cardiopulmonary bypass. pulmonary vein isolation was tested intraoperative and postoperative 30 days using a unipolar pacemaker and pathological examination of the frozen tissue obtained 30d after. Results: Cryoablation clamp can complete the simplified left atrial maze procedure, all animals were produced pulmonary vein isolation effect, histological examination showed 100% occurrence of transmural tissue damage less than 5mm thick, 91% occurred greater than 5mm organization transmural injury. Conclusion: simplified left atrial Cryoablation maze procedure can produce long-term effects of pulmonary vein isolation. The technology can guide the clinical treatment of atrial fibrillation. Key words: Atrial fibrillation；Maze operation; cryoablation 迷宫手术治疗房颤具有较高的成功率，然而其诸多弊端限制了其广泛应用[1]。外科迷宫手术的实践及基础研究表明，以二尖瓣病变为基础病变的房颤，肺静脉在内的左房后壁是房颤维持最关键的部位[2]，有报道射频消融环形隔离左、右两侧的肺静脉和左房后壁特定部位(如左、右两侧肺静脉之间和左下肺静脉与二尖瓣环之间)房颤转窦率可达60％～80％之间[3]。本实验在体外循环下采用冷冻消融完成简化左房迷宫手术，通过肺静脉隔离实验及组织病理检查证实该技术具有可靠的电隔离效果，为进一步开展临床冷冻消融房颤技术提供了技术参考。 1 材料和方法 1.1 实验动物及器械 16只家猪，体重30-40kg，隔夜空腹后，给予动物全麻，气管插管，肝素化后常规建立体外循环，主动脉根部灌注晶体停跳液心脏停跳下实施手术。4只家猪设为急性实验组， 12只家猪设为慢性实验组，分别于术后30min及30d行肺静脉隔离实验并处死取材。 冷冻治疗设备采用Surg