Robertson J M, Mulder D G
Am J Surg. 1984 Jul;148(1):86-92. doi: 10.1016/0002-9610(84)90293-9.
The indications for pericardiectomy as well as the causal factors have changed in recent years. Sixty-eight patients operated on at the UCLA Medical Center between 1955 and 1982 have been described. There were 37 male patients and 31 female patients. The indication for operation was acute pericarditis in 37 patients, of whom 31 had recurrent effusion, and chronic constrictive pericarditis in 31 patients, of whom 8 were calcific. The most common cause of pericardial disease was tumor (20 patients), followed by idiopathic (13 patients), uremic (7 patients), viral (7 patients), tuberculous (6 patients), rheumatologic (6 patients), and miscellaneous (9 patients) causes. In most patients, pericardiectomy was performed through a left anterolateral thoracotomy without cardiopulmonary bypass. We recommend wide excision of the anterior pericardium (phrenic nerve to phrenic nerve) for effusive pericarditis. For chronic constrictive disease, we advocate a more extensive resection that includes the anterior as well as the posterior pericardium, thus freeing the left and right ventricles. Excellent long-term results were obtained with pericardiectomy in 90 percent of the patients who survived the operation.
近年来，心包切除术的适应证以及病因都发生了变化。本文描述了1955年至1982年间在加州大学洛杉矶分校医学中心接受手术的68例患者。其中男性患者37例，女性患者31例。手术适应证为急性心包炎37例，其中31例有反复积液；慢性缩窄性心包炎31例，其中8例有钙化。心包疾病最常见的病因是肿瘤（20例），其次是特发性（13例）、尿毒症性（7例）、病毒性（7例）、结核性（6例）、风湿性（6例）和其他（9例）病因。大多数患者通过左前外侧开胸手术进行心包切除术，无需体外循环。对于渗出性心包炎，我们建议广泛切除前心包（从膈神经到膈神经）。对于慢性缩窄性疾病，我们主张进行更广泛的切除，包括前心包和后心包，从而松解左、右心室。90%存活下来的手术患者通过心包切除术获得了优异的长期效果。
