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目的:对梗阻性肥厚型心肌病行经皮室间隔化学消融术和外科手术室间隔切除术治疗的患者进行对照研究,观察长期疗效和安全性。方法:25例行化学消融术的梗阻性肥厚型心肌病患者,以17例手术治疗的患者作为对照组。进行术前、术后1个月、术后1年和3年的随访,包括临床的心脏事件和心脏超声等。结果:1例手术患者住院期间死亡。1例化学消融患者术后1个月时发生猝死。化学消融术中2例患者出现过一过性传导阻滞。术后患者症状缓解,心功能改善。术后1个月时室间隔厚度[手术组(14.11±1.12)mm∶化学消融组(17.68±0.82)mm,P<0.05]和左室流出道压差[手术组(22.55±6.49)mm∶化学消融组(44.13±5.93)mm,P<0.05],手术组显著小于化学消融组。随着时间延长,化学消融组患者室间隔和左室流出道压差有进一步下降。随访3年时,两组差异无统计学意义。术后有左室射血分数下降,左房左室内径增大的趋势,但两组差异无统计学意义。结论:化学消融和手术切除治疗梗阻性肥厚型心肌病,均能有效缓解症状,改善患者活动能力和心功能,术后患者长期存活。化学消融术对于药物治疗不佳的患者是手术切除治疗之外的一个较好的选择。
OBJECTIVE: To compare the efficacy of percutaneous transhepatic septal ablation and surgical resection in patients with obstructive hypertrophic cardiomyopathy and to observe the long-term efficacy and safety. Methods: Twenty-five patients with obstructive hypertrophic cardiomyopathy who underwent chemical ablation were enrolled in this study. Seventeen patients undergoing surgery were selected as control group. Preoperative, postoperative 1 month, 1 year and 3 years after the follow-up, including clinical cardiac events and cardiac ultrasound. Results: One patient died during hospitalization. One patient died of sudden death at 1 month after chemical ablation. Two patients underwent chemical ablation in a transient conduction block. Postoperative patients with symptoms, cardiac function improved. At 1 month after operation, the thickness of the interventricular septum [14.11 ± 1.12 mm in the operation group (17.68 ± 0.82 mm), P <0.05] and the pressure difference in the left ventricular outflow tract [22.55 ± 6.49 mm in the operation group Chemical ablation group (44.13 ± 5.93) mm, P <0.05], the operation group was significantly less than the chemical ablation group. As time went by, chemical ablation group patients with ventricular septum and left ventricular outflow tract pressure drop further. After 3 years of follow-up, there was no significant difference between the two groups. Postoperative left ventricular ejection fraction decreased left ventricular left ventricular diameter increased trend, but the difference between the two groups was not statistically significant. Conclusion: Chemical ablation and surgical resection of obstructive hypertrophic cardiomyopathy can effectively relieve symptoms, improve patient activity and cardiac function, long-term survival of patients after surgery. Chemical ablation is a better alternative to surgical resection in patients who are poorly medrated.