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目的 分析行二尖瓣置换术时同期行双极射频消融术对二尖瓣狭窄合并心房颤动 (房颤) 患者的围术期影响及其临床近期效果.方法 回顾性分析2016年1月至2017年6月我院因风湿性二尖瓣狭窄合并房颤而行二尖瓣置换术联合或不联合双极房颤射频消融术44例患者的临床资料,其中18例患者行二尖瓣置换术同期行双极射频消融术 (组1),26例患者行二尖瓣置换术时未行双极射频消融术 (组2).组1中,男4例、女14例,年龄43～67 (55.67±7.56) 岁;组2中,男6例、女20例,年龄40～72 (54.81±8.81) 岁.收集这些患者的基线资料、术前超声结果、手术方式、围术期情况、术后3个月复查时超声及心电图结果,分析双极射频消融术对相关患者的围术期影响及其临床近期效果.结果 两组患者手术时间差异无统计学意义 (P=0.867),组1患者术中主动脉阻断时间 (P=0.001) 及体外循环时间 (P=0.006) 较组2长,两组术后住ICU时间差异无统计学意义 (P=0.550).围手术期无患者死亡,组1中1例患者因胸腔引流液过多而二次开胸止血.术后3个月复查超声及心电图,组1中16例患者恢复窦性心率,组2中2例患者恢复窦性心率.与术前相比,两组患者术后左室射血分数 (LVEF) 变化量,肺动脉收缩压变化量,左室舒张末期内径 (LVDD) 变化量,左房径 (LAD) 变化量差异无统计学意义 (P均＞0.05).结论 对二尖瓣狭窄合并房颤患者行二尖瓣置换术同期行双极房颤射频消融术,不增加手术风险,术后转复为窦性心律的成功率较高,但对心脏术后近期结构及功能的恢复无明显积极或消极影响.“,”Objective To evaluate the short-term outcome and influence of atrial fibrillation ablation and mitral valve replacement for patients with mitral valve stenosis and atrial fibrillation. Methods Retrospective analysis was conducted for 44 patients with rheumatic mitral valve stenosis and atrial fibrillation who experienced mitral valve replacement with or without surgical atrial fibrillation ablation procedure in our hospital from January 2016 to June 2017.Eighteen patients experienced mitral valve replacement and surgical atrial fibrillation ablation procedure (a group 1), and the other 26 patients experienced mitral valve replacement without surgical atrial fibrillation ablation procedure (a group2). In th group 1, there were 4 males and 14 females, aged 43-67 (55.67±7.56) years, and in the group 2 there were 6 males and 20 females, aged 40-72 (54.81±8.81) years. The patients' data, preoperative echocardiography, surgery procedures, perioperative events, echocardiography and electrocardiogram at postoperative three months were collected to evaluate the short-term outcome and influence of surgical atrial fibrillation ablation procedure for those patients. Results There was no statistical difference in the operation duration (P=0.867) and ICU stay (P=0.550) between the two groups. But the group 1 had longer extracorporeal circulation duration (P=0.006) and aorta arrest duration (P=0.001) than the group 2.No patient died perioperatively and one patient from the group 1 experienced reoperation because of too much chest tube drainage. At three months after operation, echocardiography and electrocardiogram examination showed that 16 patients in the group 1 and 2 patients in the group 2 had sinus rhythm. There was no statistical difference between postoperative and preoperative examination about variation in left ventricle ejection fraction, pulmonary arterial systolic pressure, left atrial diameter and left ventricular end diastolic diameter between the two groups (all P＞0.05). Conclusion Atrial fibrillation ablation does not increase the risk of mitral valve replacement for patients who have mitral valve stenosis and atrial fibrillation. The rate of converting to sinus rhythm is high, but additional atrial fibrillation ablation procedure does not have positive or negative influence on short-term recovery of cardiac structure and function after operation.