Li Jianfeng, Liu Yanguo, Yang Fan, Jiang Guanchao, Li Cuilan, Hu Dayi, Wang Jun
Department of Thoracic Surgery, Peking University, People's Hospital, Beijing, China.
Ann Thorac Surg. 2008 Dec;86(6):1955-8. doi: 10.1016/j.athoracsur.2008.07.100.
The purpose of this study was to assess the feasibility and long-term effect of video-assisted thoracoscopic left cardiac sympathetic denervation for congenital long-QT syndrome.
From December 2002 to May 2007, 11 patients who could not tolerate or who were refractory to beta-blocker therapy received video-assisted thoracoscopic left cardiac sympathetic denervation. Under general anesthesia, the pleural cavity was entered through three 1.5-cm incisions in the left subaxillary area. The left thoracic sympathetic chain was identified, and the lower one third of the left stellate ganglion, together with T(2) to T(5) sympathetic chain, was resected.
The mean operative time was 40.9 +/- 7.7 minutes. Blood loss was minimal. The mean postoperative stay was 6 +/- 1.4 days. There were no major perioperative complications apart from mild ptosis of the left upper eyelid in 1 patient who subsequently recovered shortly after the procedure. The mean follow-up time was 37.0 +/- 26.3 months. Seven of the patients are totally free of cardiac events and report good quality of life. One patient experienced decreased syncopal events from 5 or 6 times per year to 2 or 3 times per year. One patient still experiences syncopal events 3 to 4 times a year, but with shortened duration to several seconds. One patient reports syncope 10 times per year. Only 1 patient died, early in the second year after surgery. In conclusion, the overall efficacy rate (that is, reduction in syncopal episodes) is 81.8% (9 of 11) and the mortality rate, 9.1% (1 of 11).
Video-assisted thoracoscopic left cardiac sympathetic denervation is a simple and minimally invasive technique that results in good long-term benefits in patients with congenital long-QT syndromes.
本研究旨在评估电视辅助胸腔镜下左侧心脏交感神经切除术治疗先天性长QT综合征的可行性及长期效果。
2002年12月至2007年5月，11例无法耐受β受体阻滞剂治疗或对其治疗无效的患者接受了电视辅助胸腔镜下左侧心脏交感神经切除术。在全身麻醉下，通过左腋前线三个1.5厘米的切口进入胸腔。识别左侧胸交感神经链，切除左侧星状神经节下三分之一以及T2至T5交感神经链。
平均手术时间为40.9±7.7分钟。出血量极少。术后平均住院时间为6±1.4天。除1例患者术后出现左上睑轻度下垂（术后不久即恢复）外，无其他重大围手术期并发症。平均随访时间为37.0±26.3个月。7例患者完全无心脏事件发生，生活质量良好。1例患者晕厥事件从每年5或6次减少至每年2或3次。1例患者仍每年发生晕厥事件3至4次，但发作持续时间缩短至数秒。1例患者报告每年晕厥10次。仅1例患者在术后第二年早期死亡。总之，总体有效率（即晕厥发作减少）为81.8%（11例中的9例），死亡率为9.1%（11例中的1例）。
电视辅助胸腔镜下左侧心脏交感神经切除术是一种简单且微创的技术，对先天性长QT综合征患者具有良好的长期益处。
