Concomitant thoracoscopic surgery for solitary pulmonary nodule and atrial fibrillation
Concomitant thoracoscopic surgery for solitary pulmonary nodule and atrial fibrillation
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胸腔镜手术治疗孤立性肺结节和房颤
DOI：
10.1093/icvts/ivx346
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发表时间：
2018
影响因子：
--
通讯作者：
Ma Nan
中科院分区：
文献类型：
--
作者：
Lu Rongxin;Mei Ju;Zhao Dongfang;Jiang Zhaolei;Xiao Haibo;Wang Mingsong;Ma Nan
目的 在过去十年中，孤立性肺结节 (SPN) 和非瓣膜性心房颤动 (NVAF) 的发病率均有所增加。我们同时进行电视胸腔镜手术和改良心外膜射频消融术，用于 NVAF 和 SPN 切除。方法 16 名患有 SPN 和 NVAF 的患者（7 名男性，平均年龄 62.6±11.2 岁）接受了该手术。这些患者中，10 名患有阵发性房颤，6 名患有持续性房颤。所有患者均接受改良心外膜射频消融联合肺静脉隔离、环向左心房消融、神经节丛消融及左心耳切除术。随后进行左肺手术。结果平均手术时间为203.1±15.6（范围177-224）分钟。所有患者均成功接受了该手术，没有转为胸骨切开术或起搏器植入。在 16 名患者中，13 名接受了肺叶切除术，3 名接受了楔形切除术。术后未出现严重并发症。平均住院时间为 9.1±1.4（范围 7-11）天，平均随访时间为 18.7±6.7（范围 8-32）个月。 1 例患者术后 6 个月房颤复发。术后第3个月未发现肺静脉狭窄。随访期间没有死亡或血栓栓塞事件。结论这种联合治疗被证明是安全的，并产生了良好的临床结果。因此，值得考虑将其作为 SPN 和 NVAF 患者的治疗方法。
OBJECTIVESThe incidence of both solitary pulmonary nodules (SPN) and non-valvular atrial fibrillation (NVAF) has increased over the past decade. We performed concomitant video-assisted thoracoscopic surgery with modified epicardial radiofrequency ablation procedure for NVAF and SPN resection.METHODSSixteen patients (7 men, mean age 62.6 ± 11.2 years) with SPN and NVAF underwent this procedure. Of these patients, 10 had paroxysmal atrial fibrillation and 6 persistent atrial fibrillation. A modified epicardial radiofrequency ablation combined with pulmonary vein isolation, circumferential left atrial ablation, ganglionic plexus ablation and left atrial appendage resection was performed for all patients. Left pulmonary surgery was carried out subsequently.RESULTSThe mean procedure duration was 203.1 ± 15.6 (range 177–224) min. All patients successfully underwent this procedure with no conversion to sternotomy or pacemaker implantation. Of the 16 included patients, 13 received lobectomy and 3 received wedge resection. No severe complications occurred postoperatively. The mean length of hospital stay was 9.1 ± 1.4 (range 7–11) days with a mean follow-up period of 18.7 ± 6.7 (range 8–32) months. One patient had AF recurrence 6 months postoperatively. No pulmonary vein stenosis was detected at the 3rd postoperative month. There were no deaths or thromboembolic events during follow-up.CONCLUSIONSThis concomitant therapy proved to be safe and yielded good clinical outcomes. Therefore, it deserves to be considered as a treatment for patients with SPN and NVAF.