Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue/Desk J4-1, Cleveland, OH, 44195, USA.
Curr Cardiol Rep. 2019 Feb 12;21(2):6. doi: 10.1007/s11886-019-1092-1.
The surgical management of constrictive pericarditis has evolved from a partial pericardiectomy via a thoracotomy approach to a more extensive removal of the pericardium. This review summarizes the published studies regarding surgical management of pericardial disease, focusing on the surgical technique of radical pericardiectomy for constrictive pericarditis.
Anterior phrenic to phrenic resection without the use of cardiopulmonary bypass has been performed in many centers. This approach achieves improvement in symptoms; however, there are patients who have progressive constriction of the remaining pericardium requiring a completion pericardiectomy. Recent studies show that the survival and functional outcome is superior after a complete pericardiectomy. Our approach is to perform a complete pericardiectomy using cardiopulmonary bypass. In experienced centers, the outcomes have significantly improved with careful selection of patients, advances in pre- and postoperative care, and refinement in surgical techniques.
缩窄性心包炎的手术治疗已从经胸部分心包切除术发展为更广泛的心包切除术。本综述总结了有关心包疾病外科治疗的已发表研究，重点介绍了用于缩窄性心包炎的根治性心包切除术的手术技术。
许多中心已在不使用体外循环的情况下进行前膈神经至膈神经切除术。这种方法可改善症状；然而，仍有部分患者剩余心包进行性缩窄，需要完成心包切除术。最近的研究表明，完全心包切除术后的生存和功能结果更好。我们的方法是使用体外循环进行完全心包切除术。在经验丰富的中心，通过仔细选择患者、术前和术后护理的进展以及手术技术的改进，显著改善了预后。
