心脏太大，取出“瘦身”后再放回去 Heart is too big,out"Thin body"Put back again after

　　南京鼓楼医院成功实施华东首例自体心脏移植术，手术时患者心脏停跳了4个多小时 Nanjing gulou hospital to succeed the implementation of the east China's first self heart transplantation,Surgery in patients with heart missed more than four hours

　　昨日，南京鼓楼医院心胸外科召开新闻发布会，宣布该院成功实施华东首例自体心脏移植术。8月23日，鼓楼医院心胸外科王东进主任为一位患有严重风湿性心脏病、心脏大如足球的患者，成功实施了自体心脏移植术，同时完成二尖瓣置换术、主动脉瓣置换术、三尖瓣成形术及房颤射频消融术。通俗地说，就是将患者的“坏心”取出体外，“整形”+“瘦身”后，再移植回体内。这也是目前国内有报道的第二例原位自体心脏移植。

yesterday,Nanjing gulou hospital of thoracic surgeons at a news conference,The hospital announced successful implementation of the east China's first self heart transplantation.On August 23,,The drum tower hospital of thoracic surgeons WangDongJin director for a severe rheumatic heart disease/The heart as big as a football of the patients,The successful implementation of the self heart transplantation,At the same time complete mitral valve replacement/Aortic valve replacement/Tricuspid valve plasty and atrial fibrillation radio frequency ablation.Popularly says,Is the patient"Bad heart"Out of body,"plastic"+"Thin body"after,Retransplantation back to the body.This is also the present domestic reports of the second case in situ self heart transplant.

　　通讯员 柳辉艳

Correspondent LiuHuiYan

　　扬子晚报记者 于丹丹

Yangzi evening news reporter YuDanDan

　　

“巨心”撑满了胸腔 "Giant heart"Brace full chest

　　是正常人三四倍，心功能仅剩30% Three or four times is normal,Cardiac function with only 30%

　　58岁的老吴来自响水，20多年前，他就感觉活动后心慌、胸闷、气喘，体力活动轻度受限，感冒及天气寒冷时症状还会加重。一方面家庭贫困，另一方面自己也未重视，所以一直没有治疗。直到4年前，老吴因感冒咳嗽在当地医院就诊时，查出患有风湿性心脏病。

58 years old LaoWu from xiangshui,More than 20 years ago,He had a feeling after activities dismayed/Bosom is frowsty/asthma,Physical activity mild restricted,A cold and cold weather when the symptom will also increase.On the one hand of the families are poor,On the other hand oneself also did not pay attention to,So there has been no treatment.Until four years ago,LaoWu because of cold cough when in a local hospital,Diagnosed with rheumatic heart disease.

　　今年7月底，患者病情进一步加重，休息时都出现心慌、胸闷、气喘，双下肢水肿，全身无力；特别是到了晚上，呼吸困难，甚至睡觉都无法平躺；由于器官供血不足，还出现少尿等症状。县医院表示无能为力，推荐他来到南京鼓楼医院找到心胸外科王东进主任。

By the end of July,With a further aggravated,When rest occurrence palpitate/Bosom is frowsty/asthma,Double leg edema,,General weakness;Especially in the evening,Difficulty breathing,Even sleep can lie low;The organ blood supply,Also appear the symptom such as oliguria.County hospital said powerless,Recommended him to find nanjing gulou hospital thoracic surgeons WangDongJin director.

　　王东进主任检查后发现，老吴因严重的风湿性心脏病导致心脏衰竭，二尖瓣、三尖瓣和主动脉瓣均严重病变，还有重度肺动脉高压等，心功能只剩下30%。

WangDongJin director examination found,LaoWu for serious rheumatic heart disease lead to heart failure,Mitral valve/Tricuspid valve and aortic lesions are serious,There are severe pulmonary arterial hypertension, etc,Cardiac function only 30%.

　　从影像上看，老吴的心脏明显扩大，体积几乎是正常人心脏的3-4倍。尤其是左心房，正常人左心房的直径一般在3.5至4厘米，而患者左心房直径达到了14厘米，左心室也扩大了近一倍。从胸片上看，患者的心脏占胸腔比例高达95%，几乎撑满了整个胸腔，而正常人这个值是小于50%的。扩大的心脏严重压迫了周围的肺组织以及食管，严重影响肺功能，还造成患者吞咽困难。

Look from the image,The heart of the LaoWu significantly increased,Volume is almost normal cardiac 3 to 4 times.Especially, the left atrial,Normal left atrium diameter generally in 3.5 to 4 cm,While patients with left atrium diameter reached 14 cm,Left ventricular also expanded nearly doubled.Look from the chest radiography,The heart of the patients of chest ratio as high as 95%,Almost stay full the whole chest,And normal person this value is less than 50%.Expand the heart serious oppression the surrounding lung tissue and esophagus,The serious influence lung function,Also caused the patients with dysphagia.

　　

传统手术不能“减负” The traditional surgery should not be"Alleviate the burden on"

　　专家决定将心脏取出来“瘦身” Experts decided to take to heart"Thin body"

　　根据患者病情，内科保守治疗已无可能，单纯的换瓣手术效果也不好。“患者心脏，尤其是左心房太大，单纯的换瓣手术无法解决因左心房扩大导致肺受压迫的问题。”王东进主任解释说，最终在综合评估患者病情后，决定在实施换瓣手术的同时，把患者的左心房取出来，进行部分切除，达到为心脏“减负”的目的。

According to patients condition,Internal medicine conservative treatment has no can,Simple change valve surgery effect is bad also."Heart patients,Especially, the left atrium is too big,Simple change valve surgery can't solve because left atrium expand cause lung oppressed problem."WangDongJin director explained,Finally, in the comprehensive evaluation of patient after illness,Decision in implementing change valve surgery at the same time,The patients to take out the left atrium,Partial resection,Reach for the heart"Alleviate the burden on"purpose.

　　通俗地说，就是将“坏心”取出体外，“整容”后再移植回体内。在医学中，这被称为“原位自体心脏移植”。其手术操作和异体心脏移植在程序上是一样的，只不过异体心脏移植是移植别人的好心脏，而自体移植是将自己的坏心脏做一番“整形”和“瘦身”后，再“装”回去。

Popularly says,is"Bad heart"Out of body,"cosmetic"After the transplant back to the body.In medicine,This is called"In situ self heart transplant".Its operation and foreign heart transplant in the procedure is the same,But foreign the heart transplant is transplant other people's good heart,And autologous transplantation is will his bad heart do something"plastic"and"Thin body"after,then"loading"back.

　　据了解，自体心脏移植最早用于某些心脏恶性肿瘤的切除中。1999年，国外专家首先将其应用于瓣膜病导致过大左心房的治疗。而2010年，北京协和医院才在国内首开先河，开展了首例原位自体心脏移植。

It is understood,Self heart transplant the first used for some cardiac malignant tumor excision of.In 1999,,Foreign experts first applied to the valve disease causes too much left atrium treatment.And in 2010,Beijing union medical college hospital just in the domestic first open first,To carry out its first in situ self heart transplant.

　　

255分钟心脏停跳 255 minutes for a stopped heart

　　将冰屑铺在胸腔内做手术 Will flake ice shop in the chest cavity surgery

　　通过精心准备，8月23日，以王东进主任、潘俊博士以及麻醉师骆璇、体外循环师陈扬为首的手术团队如期为患者进行了手术。

Through the careful preparation,On August 23,,To WangDongJin director/PanJun, PhD, and LuoXuan an anesthesiologist/Extracorporeal circulation division ChenYang led the surgical team as patients undergoing surgery.

　　早上10点，麻醉等一系列准备过后，医生打开老吴的胸腔，一个巨大的心脏呈现眼前，“好像一个足球那么大，”王东进主任回忆说。

10 o 'clock in the morning,After a series of anesthesia to,The doctor LaoWu open the chest,A huge heart present eyes,"Like a football so big,"WangDongJin director recalls.

　　11点15分，在体外循环心脏停跳后，切断上、下腔静脉、主动脉及肺动脉后，患者老吴的心脏被取出。鼓楼医院心胸外科团队先环形切除大部分左心房壁，并对残留左心房及右心房进行房颤射频消融，在完成二尖瓣置换、主动脉瓣置换和三尖瓣成形术后，心脏再予以缝合回原位心包腔。

11 point 15 points,In extracorporeal circulation after stopped heart,Cut off on/Inferior vena cava/Aortic and pulmonary artery after,Patients LaoWu heart is removed.The drum tower hospital of thoracic surgeons team first ring resection of most of the left atrial wall,And the residue left atrium and right atrium in atrial fibrillation radio frequency ablation,Upon completion of mitral valve replacement/Aortic valve replacement and tricuspid valve after angioplasty,The heart to be suture back in situ pericardial cavity.

　　王东进主任告诉记者，在将患者的心脏取出后，并不是想象中那样，把心脏放在盛满冰块的盆里面进行手术，“为了保护其他的脏器，我们还是选择将心脏放在胸腔内进行手术。”王东进说，为了保持胸腔的低温环境，也需要在胸腔内放置冰块，但为了怕冰块冻伤器官，他们把用生理盐水冻成的冰块，磨成冰屑铺在患者的胸腔里面。同时，为了让患者的心脏在停跳时心肌细胞不坏死，为患者的心脏注入了心肌保护液，这样心脏在没有血液供应的条件下，也能维持4-5个小时。

WangDongJin director told reporters,In the heart of the patients will remove,And is not imagination in that way,In the heart filled with ice basin inside an operation,"In order to protect the other organs,We still choose to chest surgery in the heart."WangDongJin said,In order to keep the chest of the low temperature environment,Also need to be placed in the chest in ice,But in order to be afraid of ice frostbite organ,They put with physiological saline frozen into ice,Ground into flake ice shop in the patient's chest inside.At the same time,In order to make the patients with heart stopped in the myocardial cell not necrosis,As the heart of the patients with myocardial protection into the liquid,So the heart without blood supply conditions,Also can maintain four to five hours.

　　下午3点30分，经过255分钟后，患者心脏顺利复跳。直到晚上7点，历时9个多小时的手术终于顺利结束，病人被转入监护室接受监护和护理。

At about 3:30 p.m.,After 255 minutes,Patients heart smooth complex jump.Until 7 PM,Lasted nine hours of surgery finally ended smoothly,Patients were into the medicine accept monitoring and nursing.

　　目前，患者心功能恢复良好，超声显示左心房直径从术前的14厘米已缩至6.6厘米。明天，老吴将正式出院，而王东进主任说，经过一段时间的康复，他的心功能也将恢复至接近常人水平。

At present,Patients with cardiac function recovered well,Ultrasonic display left atrium diameter from preoperative 14 cm has narrowed to 6.6 cm.tomorrow,LaoWu will formally discharge,And WangDongJin director said,After a period of rehabilitation,His heart function will also restore to close to normal level.

　　

-专家介绍 - expert introduction

　　自体移植比异体移植风险高得多 Autologous than allograft risk much higher

　　与异体心脏移植相比，自体心脏移植手术的难度和风险更高，为什么这么说呢？ 王东进主任解释说，这主要体现在三个方面。

Compared with foreign heart transplantation,Self heart transplant and difficulty of the higher risk,Why do you say that? WangDongJin director explained,This is mainly embodied in three aspects.

　　一，异体心脏移植是将正常的心脏移植给患者，而自体心脏移植移植的是本来就有病的心脏，同时还要在“坏心”上先完成双瓣置换手术，术后心功能的康复将遭受考验。二，左心房壁像长期被撑着的皮球壁一样，又薄又脆，在这样的组织上进行切割和缝合，如果针眼稍大一点，都会引起出血。三，取出来的心还要再放回去，但是原来的心脏形状都变了，如何和血管“对上”也是个难题。

a,Foreign heart transplant is normal heart transplant patients,And self heart transplant transplantation is originally a sick heart,But also the"Bad heart"The first complete double disc replacement surgery,Postoperative cardiac function rehabilitation will suffer from test.two,Left atrial wall like long-term support of the ball as wall,, thin and fragile,In this tissue cutting and sewing,If a little bigger stythe eye of a needle,Can cause bleeding.three,Take heart and put it back again,But the original heart shape have changed,How to and vascular"on"Is also a difficult problem.