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目的:通过与传统放射线引导方法相比较,评价完全超声引导下经皮肺动脉瓣球囊成形术(PBPV)的安全性和有效性。方法:收集我院2013-03至2016-08完全超声引导下行PBPV患者102例(超声组),同期传统放射线引导下行PBPV患者280例(放射线组)。两组患者术后均以超声心动图进行随访和评价治疗效果。结果:两组患者年龄、体重、肺动脉瓣环直径、术前肺动脉瓣跨瓣压差、球囊直径、术后即刻跨瓣压差、住院时间及住院费用差异均无统计学意义(P均>0.05)。超声组和放射线组手术成功率分别为99.0%和100%(P=0.267),超声组有1例患者因扩张后右心室流出道肌肉痉挛转为常规外科手术。放射线组术中操作时间(min)长于超声组(38.9±9.2比34.6±10.0,P<0.001),放射线组放射线时间为(3.9±1.2)min。术后门诊平均随访(25.5±13.2)个月,超声组和放射线组肺动脉瓣跨瓣压差(mm Hg,1 mm Hg=0.133 k Pa)分别为(16.2±4.3比15.3±4.5,P=0.120),两组患者均无死亡、外周血管损伤、心脏穿孔、心包积液等严重并发症。结论:完全超声引导下PBPV不仅能够完全避免放射线及对比剂,而且保持了传统经皮介入治疗微创、安全及疗效确切的优点。
OBJECTIVE: To evaluate the safety and efficacy of percutaneous pulmonary valvuloplasty (PBPV) under complete ultrasound guidance by comparison with conventional radiological guidance methods. Methods: Totally 102 patients with ultrasound-guided PBPV (ultrasound group) were collected from 2013-03 to 2016-08 in our hospital. 280 patients (radiation group) underwent conventional radiation-guided PBPV. All patients were followed up by echocardiography and the therapeutic effect was evaluated. Results: There was no significant difference in age, body weight, diameter of pulmonary valve annulus, preoperative pulmonary valve transvalvular pressure, balloon diameter, postoperative transvalvular pressure, hospitalization and hospitalization costs (P> 0.05). The successful rates of ultrasound and radiotherapy were 99.0% and 100%, respectively (P = 0.267). One patient in the ultrasound group was converted to conventional surgery because of muscle spasms in the right ventricular outflow tract after dilatation. The operation time (min) of the radiotherapy group was longer than that of the ultrasound group (38.9 ± 9.2 vs. 34.6 ± 10.0, P <0.001), and the radiotherapy time was (3.9 ± 1.2) min. After an average follow-up of 25.5 ± 13.2 months, the pulmonary valvular pressure difference (mm Hg, 1 mm Hg = 0.133 kPa) between the ultrasound group and the radiotherapy group was (16.2 ± 4.3 vs. 15.3 ± 4.5, P = 0.120 ), No deaths, peripheral vascular injury, perforation of the heart and pericardial effusion were found in both groups. Conclusion: Complete ultrasound guided PBPV can not only completely avoid radiation and contrast agent, but also keep the advantages of minimally invasive, safe and effective treatment with traditional percutaneous interventional therapy.