Park Bernard J, Zhang Hao, Rusch Valerie W, Amar David
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):775-9. doi: 10.1016/j.jtcvs.2006.09.022.
The objective was to define the incidence of atrial fibrillation after video-assisted thoracic surgery lobectomy and determine whether video-assisted thoracic surgery reduces atrial fibrillation rate compared with thoracotomy.
With the use of a single-institution database of patients who underwent lobectomy for clinical stage I non-small cell lung cancer, 389 patients were identified who were in sinus rhythm preoperatively and received no prophylactic antiarrhythmics. Patients undergoing video-assisted thoracic surgery were age and gender matched with those undergoing thoracotomy.
After matching, 122 patients undergoing video-assisted thoracic surgery and 122 patients undergoing thoracotomy were eligible for analysis. Patients undergoing video-assisted thoracic surgery had a higher preoperative diffusion capacity (92% +/- 28% vs 80% +/- 18% predicted, P = .001) and a lower rate of induction chemotherapy (5/122, 4% vs 11/122, 11%, P = .05) than patients undergoing thoracotomy. Atrial fibrillation occurred in 12% of patients (15/122) undergoing video-assisted thoracic surgery and 16% of patients (20/122) undergoing thoracotomy (P = .36). Overall, complications were lower in the video-assisted thoracic surgery group (17.2% vs 27.9%, P = .046). Patients with atrial fibrillation were older in both video-assisted thoracic surgery (73 +/- 7 years vs 66 +/- 9 years, P = .002) and thoracotomy groups (72 +/- 7 years vs 66 +/- 10 years, P = .005). Length of stay for patients with atrial fibrillation was greater in both video-assisted thoracic surgery (6.0 +/- 1.5 days vs 4.7 +/- 2.5 days, P = .01) and thoracotomy groups (9.2 +/- 4.3 days vs 6.8 +/- 3.6 days, P = .03).
Regardless of surgical approach, atrial fibrillation after lobectomy occurred with equal frequency. This supports the theory that autonomic denervation and stress-mediated neurohumoral mechanisms are responsible for the pathogenesis of postoperative atrial fibrillation. Prophylaxis regimens against atrial fibrillation should be the same for either operative approach.
本研究旨在确定电视辅助胸腔镜手术肺叶切除术后房颤的发生率，并确定与开胸手术相比，电视辅助胸腔镜手术是否能降低房颤发生率。
利用单机构数据库中因临床I期非小细胞肺癌接受肺叶切除术的患者，确定389例术前为窦性心律且未接受预防性抗心律失常药物治疗的患者。接受电视辅助胸腔镜手术的患者在年龄和性别上与接受开胸手术的患者相匹配。
匹配后，122例接受电视辅助胸腔镜手术的患者和122例接受开胸手术的患者符合分析条件。接受电视辅助胸腔镜手术的患者术前弥散功能较高（预计值为92%±28% vs 80%±18%，P = 0.001），诱导化疗率较低（5/122，4% vs 11/122，11%，P = 0.05）。12%的电视辅助胸腔镜手术患者（15/122）发生房颤，16%的开胸手术患者（20/122）发生房颤（P = 0.36）。总体而言，电视辅助胸腔镜手术组的并发症较少（17.2% vs 27.9%，P = 0.046）。电视辅助胸腔镜手术组（73±7岁 vs 66±9岁，P = 0.002）和开胸手术组（72±7岁 vs 66±10岁，P = 0.005）中发生房颤的患者年龄更大。电视辅助胸腔镜手术组（6.0±1.5天 vs 4.7±2.5天，P = 0.01）和开胸手术组（9.2±4.3天 vs 6.8±3.6天，P = 0.03）中发生房颤的患者住院时间更长。
无论手术方式如何，肺叶切除术后房颤的发生率相同。这支持了自主神经去神经化和应激介导的神经体液机制是术后房颤发病机制的理论。两种手术方式针对房颤的预防方案应相同。
