慢性缩窄性心包炎的手术治疗及相关因素探讨.doc

慢性缩窄性心包炎的手术治疗及相关因素探讨 　　作者：杨双强 李良彬 李强 　　【摘要】 目的 总结分析203例慢性缩窄性心包炎患者施行心包剥脱术的治疗体会，探讨影响手术疗效的相关因素。方法 对1960～2001年期间，203例因缩窄性心包炎行心包剥脱术的患者临床资料进行回顾性研究。从手术时机的选择、病因、心包剥脱范围以及并发症处理等方面进行讨论。结果 203例中手术死亡6例，手术死亡率为2.96%;其余197例(97.05%)症状均明显缓解出院。189例(93.10%)获得长期随访，随访期6个月～31年(平均12.23±7.61年)。绝大多数患者术后6个月内心功能恢复至Ⅰ～Ⅱ级，能从事中等程度体力劳动以上141例(74.60%)，症状改善者42例(22.22%)，无明显改善者6例(3.17%)。晚期复发心包缩窄或因心力衰竭死亡7例(3.45%)。结论 心包剥脱术是治疗慢性缩窄性心包炎的可靠有效方法，根据病情选择适当的手术时机，尽早剥除缩窄心包，加强围手术期处理，可获得更优的治疗效果。 　　关键词 慢性缩窄性心包炎 心包剥脱术 　　Surgical treatment of chronic constrictive pericarditis for203patients 　　Yang Shuangqiang，Li Liangbin，Li Qiang，et al. 　　Department of Cardiothoracic Surgery，the First Affiliated Hospital， 　　Chongqing University of Medical Sciences，Chongqing400016. 　　【Abstract】 Objective To summarize the experiences of surgical treatment for203patients with chronic conˉstrictive pericarditis for whom pericardiectomy procedures were performed，and to explore the relative factors influencˉing operative effect.Methods Retrospective study on203pericardiectomy cases from1960to2001were carried out based on clinical data，and discussion were focused on various issues such as selection of operative opportunity，etioloˉgy，pericardiectomycoverage，and complication managament，etc.Results There were6early mortality cases(2.96%)and197survival discharged cases(97.05%)among all203patients.Long-term follow-up were obtained from189cases(93.10%)since3months to41years(averaged12.23±7.61years).Most of the patients were reˉcovered to NYHAⅠ～Ⅱclass within6months after pericardiectomy，with141cases(74.60%)moderate labour，42cases(22.22%)symptom improvement，and6cases(3.17%)no improvement.7late mortality cases(3.45%)beˉcause of refractory constrictive pericarditis and heart failure were discovered.Conclusion Pericardiectomy is an effecˉtive surgical treatment for chronic constrictive pericarditis patients.Optimal clinical outcome would be reached if the right time for operation was selected and constrictive pericardiumwas r