经胸腔镜行左侧心交感神经切除术治疗长QT综合征

探讨β 阻断剂治疗无效的长QT综合征 (LQTS)的经胸腔镜行左侧心交感神经切除术 (LCSD)的疗效 ,选择 4例确诊为LQTS ,服用 β 阻断剂效果不佳的患者进行LCSD。 4例手术均成功 ,其中只有 1例发生短暂的左眼充血和Horner′s综合征 ,但随后症状逐渐减轻 ,出院时症状几乎完全消失。术中切除神经节后即有校正的QT间期 (QTc)缩短 ,由 0 .5 4± 0 .0 8s降低到 0 .5 1± 0 .0 6s(P =0 .0 96 ,n =4 )。 2 4h动态心电图上测得的平均QTc术后与术前相比也有不同程度的缩短。卧式踏车运动试验显示 ,手术前 ,病人运动后T波形态较之运动前有很大变化 ;而手术后运动后T波形态较之运动前则很少发生变化 ;另外 ,术前运动后QTc升高较多 ,而术后运动后QTc变化很小 ,提示术前LQTS病人受交感神经影响较大 ,而术后LQTS病人较少受交感神经的影响 ,说明切除交感神经的效果明显。术后跟踪随访 5个月 ,仅 1例术前经常发作长时间晕厥的患者发生过 2次时间短暂的晕厥 ,初步显示LCSD手术对服用β 阻断剂无效的LQTS有效

Left Cardiac Sympathetic Denervation Via Thoracoscope to Treat Long QT Syndrome

To explore the effect of left cardiac sympathetic denervation(LCSD)via thoracoscope for treating LQTS,4 LQTS patients who were resistant to β blockade were selected and underwent LCSD.4 surgeries were all successful.In one patient,hyperemia of the left eye and Horner′s syndrome occurred,but decreased later and disappeared after a week.The QTc was shortened immediately from 0.54±0.08 s to 0.51±0.06 s ( P=0.096,n =4) after the removal of the ganglion.The mean QTc measured from 24 hour Holter monitoring electrocardiogram was shortened after surgery in 3/4 patients.The horizontal bike exercise test demonstrated that before surgery the post exercise T wave morphology was changed much more than that for pre exercise;and after surgery the post exercise T wave morphology was less changed than that for pre exercise.Moreover,the post exercise QTc increased more before surgery than that after surgery,suggesting that patients were less influenced by sympathetic nerve after surgery.This proved the effects of removal of sympathetic ganglion.5 month follow up showed that there were two episodes of transient syncope occurred in one patient who was attacked by long time syncope episodes frequently before surgery.The preliminary result shows that LCSD is effective for LQTS patients who were resistant to β blockade.