摘要
目的对比外环缩缝合和线性缝合两种术式治疗室壁瘤的效果。方法室壁瘤模型兔30只，外环缩缝合组和线性缝合组各15只。外环缩缝合模拟左室几何成形，在室壁瘤与正常心肌的交界处用3-0 prolene线荷包环缩缝合。线性缝合模拟Cooley经典线性缝合，以平行前降支的方向，双侧加人工血管垫片、连续、折叠缝合，消除室壁瘤。术中经心尖部、术后2周经颈动脉测左室收缩末压（LVESP）和舒张末压力（LVEDP）。术前和术后2周用超声心动图测量左心室前后径、长径、室间隔及左室后壁厚度、左室舒张末容积（LVEDV）、收缩末容积（LVESV）和射血分数（EF），并用琼脂做左室腔内铸型，观察左室立体形态。结果实验动物每组各死亡2只，总存活率86．7％。两种术式成形后原室壁瘤基本消失，与术前比较，两组LVEDV和LVESV均显著缩小，EF显著升高。两组间比较，术后LVEDV差异无统计学意义，但外环缩组LVESV显著低于线性缝合组，EF显著高于线性缝合组，且增加的程度也高于线性缝合组。两组术后LVEDP均显著下降，但线性缝合组显著高于外环缩缝合组。左室腔内铸型显示，外环缩缝合术后左室立体构型恢复正常锥形结构，而线性缝合术后左室形状未能恢复锥形。结论外环缩缝合法与线性缝合法均能改善室壁瘤的左室功能，外环缩缝合法可能优于线性缝合法。
Objective To compare the early results of circular purse reconstruction and linear repair to reshape left ventricle with aneurysm on beating heart without eardiopulmonary bypass. Methods Thrity rabbits with left ventrieluar aneurysm （LVA） were divided into two group. Circular purse reconstruction imitating geomeitrie reconstruction was performed by a circular purse suture of 3-0 polypropylene placed at the adjunetion between the contractile myecardium and aneurysm. After tying, the aneurysm was eliminated. Linear repair which imitated Cooley＇s approach was performed using a nmning 3-0 polypropylene suture placed parallel to left anterior descending artery to plicate the aneurysm. Before surgery and two weeks later, LVESP and LVEDP were directly measured. LV dimension and LVEDV and LVESV and EF were also investigated by echocardiography. Agar intra-chamber cast was used to show the geometric structure of LV after aneurysm surgery. Results Twenty six （86.7 % ） rabbits survived the operation. Echocardingraphy showed that in both group, aneurysm was eliminated and the LV dimension, LVEDV, and LVESV were significantly decreased and EF increased. The postoperative LVESV of circular purse group was smaller than that of linear repair group and EF was higher. In both group, LVESP increased but LVEDP significantly decreased. LVEDP of purse reconstruction group was significantly lower than that of linear repair group. Agar intra-chamber cast showed that after circular puse reconstruction, LV maintained a geometrc structure much better than that of linear repair. Conclusion Both circular reconstruction and linear repair can improve LV function and the former is probably better than the later.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2008年第5期330-333,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏室壁瘤
心室重构
心脏外科手术
Heart aneurysm V entricular remodeling Cardiac surgical procedures
