【摘要】 目的探讨缩窄性心包炎患者行再次心包剥脱术的手术适应证及手术方法,评价中远期生存率、并发症以及疗效。方法 2003年3月至2012年11月,13例缩窄性心包炎患者(12例男性,1例女性,年龄16~62岁,平均43.5±15.7岁)在我科接受了再次心包剥脱术,两次手术间隔4~480个月,平均(133.9±135.1)个月。术前心功能分级(NYHA)Ⅱ级3例,Ⅲ级9例,Ⅳ级1例。8例于体外循环下行再次心包剥脱术,其中3例同期行瓣膜手术。术后随访患者的生存情况、心功能以及并发症。结果全组1例手术死亡,1例术后出现严重并发症(呼吸机撤机困难、急性肾功能不全以及肺部感染)。全组术后中心静脉压(central venous pressure,CVP)与术前比较明显下降,差异有统计学意义(P=0.001)。1例术后第4年死亡,死于顽固性心功能不全。1例失访,其余10例均得到随访,随访率91.7%。随访18~134个月,平均(68.2±35.9)个月。术后NYHAⅠ级1例,Ⅱ级7例,Ⅲ级2例。与术前相比,术后心功能分级(NYHA)明显好转,差异有统计学意义(P=0.034)。首次术后症状曾有明显缓解者与无明显缓解者相比,再次手术后生存率(60%vs.100%,P=0.043)以及术后症状明显改善的比例(0vs.85.7%,P=0.001)均明显不如后者。体外循环组与非体外循环组相比,术后生存率较高(100%vs.60%),但差异无统计学意义(P=0.07);术后CVP、术后心功能分级、手术时间以及总输血量均无明显差异。结论缩窄性心包炎再次心包剥脱术的手术风险较大。首次术后症状无明显缓解者再次手术后心功能明显改善。体外循环下行再次心包剥脱术更加安全、彻底。更多还原

【Abstract】 Objective To discuss the surgical indications and options of redo pericardiectomy for recurrent constrictive pericarditis,and to evaluate the long-term survival,complications,and benefits of surgery. Methods From Mar,2003 to Nov,2012,13 patients with recurrent constrictive pericarditis underwent redo pericardiectomy in our hospital(12males,1female;average age(43.5±15.7)years,ranging from 16 to 62years).Mean time between pericardiectomies was(133.9±135.1)mounths,ranging from 4to 480 months.Before the surgery,there were 3cases of NYHA Ⅱ,9cases of NYHAⅢ,and 1case of NYHA IV.Cardiopulmonary bypass was used in 8patients,3of them had concomitant valve procedures,including 2MVR+TVP and 1DVR+TVP.Post-operative indices were followed up,such as vital status,functional class and complications. Results There was 1case of early mortality,and 1case had serious complications after surgery(difficult weaning of mechanical ventilation,acute renal injury and pneumonia).Central venous pressure(CVP)significantly decreased after the surgery(P=0.001).One patient died of cardiac failure 4 years after redo pericardiectomy.10 patients(91.7%)were followed up,with a mean follow-up time of(68.2±35.9)months.There was statistical difference between post-operative and pre-operative functional class(P=0.034).For those who ever had benefits from initial operations,after redo operations,the rates of survival and improved functional status were inferior comparing to those who didn′t get benefits from initial operations(60%vs.100%,P=0.043;0vs.85.7%,P=0.001).On-pump reoperations showed better survival than off-pump,although not statistically significant(100% vs.60%,P=0.07).No statistical difference in surgery duration,blood transfusions,post-operative CVP and functional class was noted between these two groups. Conclusions The operative risk for redo pericardiectomy was high.Those who didn′t get benefits from initial operations could improve significantly after redo operations.On-pump redo pericardiectomy was more safe and thorough.更多还原