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目的:通过对介入封堵治疗的室间隔缺损患者进行中长期临床随访,并和同期行外科修补手术的室间隔缺损患者进行对比,分析两种术式对心脏瓣膜功能的影响。方法:选择行介入封堵治疗患者279例(介入组),行外科手术修补治疗患者243例(手术组)。利用超声心动图检查瓣膜反流发生情况及随访转归情况,并对两组瓣膜反流的发生率进行对比研究。结果:术后短期介入组二尖瓣反流发生率较手术组高(P<0.05),三尖瓣和主动脉瓣反流发生率两组相比无统计学差异。中长期随访中,三尖瓣反流、主动脉瓣反流以及二尖瓣反流两组相比均无统计学差异。结论:室间隔缺损介入封堵治疗疗效确切,安全性高,创伤较小。术前利用超声心动图对患者的严格筛选,术中熟练轻柔稳定的操作和适合封堵器的选择是减少介入封堵术后发生瓣膜反流最重要的因素。
OBJECTIVE: To compare the long-term clinical follow-up of patients with ventricular septal defect treated by occlusion and the patients with ventricular septal defect undergoing surgical repair during the same period, and to analyze the effects of the two procedures on the function of the heart valve. Methods: A total of 279 patients (intervention group) who underwent occlusion therapy and 243 patients who underwent surgical repair (surgery group) were selected. Echocardiography was used to check the occurrence and follow-up of valvular regurgitation. The incidence of valve regurgitation in both groups was compared. Results: The incidence of mitral regurgitation in the short-term intervention group was significantly higher than that in the surgery group (P <0.05). There was no significant difference in the incidence of tricuspid regurgitation and aortic regurgitation between the two groups. In the long-term follow-up, tricuspid regurgitation, aortic regurgitation, and mitral regurgitation were not significantly different between the two groups. Conclusion: Interventricular septal defect interventional therapy is effective, safe and less invasive. Preoperative use of echocardiography in patients with rigorous screening, intraoperative gentle and stable operation and suitable for the selection of occluder is the most important factor in reducing valve regurgitation after interventional occlusion.