摘要
目的:探讨经食管超声心动图(TEE)技术在肥厚性梗阻型心肌病(HOCM)室间隔部分切除术中的应用价值。方法:回顾性调查41例HOCM患者经室间隔部分切除术治疗的临床资料,依据术中是否应用TEE分为TEE组和非TEE两组,比较术前、术后两组左室流出道压力阶差(LVOTG)、室间隔厚度、左室后壁厚度、左房内径、左室内径、左室射血分数、二尖瓣前向运动(SAM征)等超声参数及二尖瓣手术方式、临床症状及并发症情况。结果:术前两组超声参数比较差异无统计学意义(P>0.05)。术后TEE组LVOTG、室间隔厚度、左房内径、左室内径、SAM征与术前比较有统计学意义(P<0.05),左室后壁厚度、左室射血分数与术前比较无统计学意义(P>0.05);非TEE组术后LVOTG、室间隔厚度及SAM征与术前比较有统计学意义(P<0.05),左室后壁厚度、左房内径、左室内径、左室射血分数与术前比较无统计学意义(P>0.05);术后两组LVOTG、左房内径、左室内径、SAM征比较差异有统计学意义(P<0.05),室间隔厚度、左室后壁厚度、左室射血分数比较无统计学意义(P>0.05);TEE组二尖瓣手术方式、扩大M aorrow术与非TEE组比较差异有统计学意义(P<0.05);TEE组临床症状的改善与非TEE组比较差异有统计学意义(P<0.05)。结论:TEE在室间隔部分切除术治疗HOCM中对二尖瓣手术方式的选择具有决定性作用,可以明显提高手术的成功率,明显改善患者的临床症状,降低并发症,对手术具有监测和指导作用。
Objective：This study was designed to explore the clinical value of intraoperative transesophageal echocardiography （TEE） in surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy. Methods：Of 41 patients with HOCM treated by surgical myectomy,30 patients used TEE （Gy group）and 11 patients didn＇t use TEE （Gn group）. Pre and post operational data such as left ventricular outflow tract pressure gradient（ LVOTG）, IVST, PWLV,internal diameters of left auricle and ventricle, ejection fraction of left ventricle, SAM, mitral valve operation method, clinical symptoms, and complications were investigated retrospectively and compared between the two groups. Results：Pre-operational ultrasound parameters between the two groups showed no significant difference （P 〉 0.05）, and post-operational LVOTG, IVST, Sam and the internal diameters of left auricle and ventricle showed statistical significance when compared with than that of pre-operation in Gy group （P 〉 0.05 ） ; but posterior left ventricular wall and ejection fraction showed no statistical significance （P 〉 0. 05）, when compared with that of pre-operation. In Gn group, post-operational LVOTG, IVST, and Sam showed statistical significance when compared with that pre-operation （P 〈 0. 05） ;post-operational data of the left atrial diameter,left ventricular diameter, posterior ventricular wall and ejection fracture showed no difference when compared with that pre-operation （P 〉 0.05）, but LVOTG, SAM, diameters of left atrium and left ventricle of the two groups showed statistical difference （P 〈 0.05） post-operation; while no statistical difference in IVST, PWLV, and ejection faction was shown （ P 〉 0.05 ） ; there was statistical difference between the two groups （ P 〈 0.05 ） in miral valve operation methods and enlarged Mamav operation, and there was statistical difference in the improvement of clinical symptoms between Gy and Gn groups （P 〈 0. 05）. Conclusion：Intraoperative TEE can increase rate of surgical success and has important impact on options of therapeutic methods of mitral valve and improve clinical symptoms and decrease complication in surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy （ HOCM ）.
出处
《临床误诊误治》
2008年第11期4-7,共4页
Clinical Misdiagnosis & Mistherapy
关键词
心肌病
肥厚梗阻型
超声心动图
室间隔
外科手术学
Cardiomyopathy,hypertrophic obstructive
Echocardiography
Interventricular septum
Surgery
