室间隔部分切除术与消融术治疗肥厚型梗阻性心肌病患者的早期效果分析
Comparison of early clinical effects of ablation with surgery treatment in patients with hypertrophic cardiomyopathy
目的 探讨室间隔部分切除术和经皮室间隔化学消融术(PTMSA)的肥厚型梗阻性心肌病(HOCM)患者临床特征及术后早期效果.方法 回顾性选择2006年1月1日至2016年12月31日在首都医科大学附属北京安贞医院进行室间隔部分切除(手术组135例)或经室间隔化学消融(介入组69例)的HOCM患者,治疗前及治疗后1至2周内进行心脏超声检查,比较两组患者治疗前后室间隔厚度、左室流出道压差变化及短期内并发症发生情况.结果 手术组患者135例,年龄(46±14)岁,男性76例(56.3%),介入组患者69例,年龄(47±11)岁,男性51例(73.9%).两组年龄、性别、出现症状及诊断时间、晕厥症状、家族史、房颤方面比较差异无统计学意义(P>0.05).与治疗前相比,手术组室间隔厚度(22.17 mm比18.31 mm,P<0.05)、左室流出道压差[82.74 mmHg比16.55 mmHg(1 mmHg=0.133 kPa),P<0.05]均下降,介入组室间隔厚度(21.70 mm比19.27mm,P<0.05)、左室流出道压差(77.71比26.68 mmHg,P<0.05)均下降,以手术组降低更为明显(P<0.05).而手术组患者平均住院时间明显长于介入组(18.57 d比9.35 d,P<0.001).手术组和介入组患者在术后2周内并发症发生情况差异无统计学意义(P>0.05).讨论 室间隔部分切除术与PTMSA均可有效降低LVOT梗阻的情况,手术治疗效果更为明显,且常常可同时修复或置换二尖瓣改善其反流,但是住院时间较消融组长,两组短期内并发症发生情况无差异.
更多Objective To compare the early clinical effect of septal myectomy and percutaneous transluminal septal myocardial ablation (PTMSA) on the left ventricular outflow obstruction and the rate of complication in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods A total of 204 patients with HOCM who received septal reduction treatment were recruited.These patients were divided into two groups,surgery group (n =135) (65 patients with modified Morrow procedure,70 patients with non Morrow myomectomy) and PTMSA group (n =69).The baseline characteristics,disease status,other history of surgery and echocardiography parameters before and after septal reduction were collected,as well as the complication within 1 week after operation.Results The mean age in surgery group was (46 ± 14) years old,with 76 males (56.3%);mean age was (47 ± 11) years old and with 51 males (73.9%) in PTMSA group.There was no significant difference in age,gender,the time of symptom and diagnosis,syncope,family history and atrial fibrillation between the two groups (all P > 0.05).The proportion of mitral valve prolapse in the surgery group was higher than that in PTMSA group (75.8% vs 44.2%,P < 0.05).Baseline left ventricular outflow tract (LVOT) gradient was comparable (82.7 mmHg in surgery group vs 77.7 mmHg in PTMSA group,P > 0.05).The mean resting LVOT gradient after septal reduction therapy was lower (16.55 mmHg in surgery group,26.68mmHg in PTMSA group) than that before operation,with lower gradient in surgery group (P < 0.05).Compared with PTMSA group,the duration of hospitalization was longer in surgery group (P < 0.05).There was similar rate of operation related complications in the two groups.Conclusions Both septal reduction therapies can improve the LVOT obstruction,more significant in surgery group,but with longer hospital stay.The rate of operation related complication is similar in both groups.
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