2005至2006年全军结构性心脏病介入治疗现状分析

lnterventional therapy for structural heart diseases in People＇s Liberation Army hospitals between 2005 and 2006

目的总结全军38所医院2005年1月至2006年12月开展结构性心脏病介入治疗的疾病、数量及出现的并发症，为今后开展此类手术提供指导和借鉴。方法通过统一问卷收集全军各医院2005年1月至2006年12月介入治疗结构性心脏病的病例资料统计表，包括实施介入治疗的病例数量、成功例数以及各种介入治疗出现的并发症，然后进行数据统计学分析。结果共收回38所医院资料统计表。2年期间共进行介入治疗8862例，成功8692例，成功率98．08％。其中室间隔缺损（VSD）、房间隔缺损（ASD）、动脉导管未闭（PDA）、二尖瓣狭窄（MS）和肺动脉瓣狭窄（Ps）5种疾病介入治疗8684例，占介入治疗总数的97．99％，而其他少见心脏畸形的介入治疗仅占2．01％。在所有封堵术治疗中，进口封堵器使用率仅占8．77％，而国产封堵器使用率高达91．23％。共出现并发症384例，并发症发生率4．33％，其中VSD并发症发生率最高，达9．72％，占全部并发症的84．38％。所有并发症中最常见者为各种传导阻滞（260例），其次是残余分流（42例），封堵器脱落（30例）和三尖瓣关闭不全（22例）。相对于2003至2004年，介入治疗病例增长57．32％，成功率略有降低，并发症发生率也呈现降低趋势。结论随着介入治疗经验的成熟，介入治疗成为治疗结构性心脏病安全有效的方法。部分并发症需要长期随访才能发现，如何做好介入治疗后的长期随访是今后的重点。

Objective To evaluate the efficacy and safety of interventional therapy in structural heart diseases in 38 PLA hospitals. Methods Data including patient number underwent interventional therapy for structural heart disease, procedure details, immediate procedural complications were retrospectively collected in all the military hospitals between January 2005 and December 2006. Results Successful interventional therapy was achieved in 8692 out of 8862 patients （98.08%） with structural heart disease. Transcatheter closure of ventricular septal defect （VSD）, atrial septal defect （ASD） and patent ductus arteriosus （PDA）, and percutaneous balloon dilatation of mitral valve stenosis （MS） and pulmonary valve stenosis （PS） were the most performed procedures （97.99%）. Up to 91.23% patients underwent transcatheter closure with domestic devices. The incidence of prooedure-related complications was 4.33% （n = 384 ） which were most frequently associated with VSD closure. The commonest procedural complications included conduction blockades （ n = 260）, residue shunt （ n = 42）, device detachment （ n = 30） and tricuspid incompetence （ n = 22）. Although the procedures performed in 2005 and 2006 increased 57.32% compared with those in 2003 and 2004, the success rate and the incidence of complications remained unchanged. Conclusion Percutaneous treatment of structural heart disease is a safe and feasible alternative to surgery. Somelate complications arise long after the treatment, which suggests the importance of long-term follow-up for those patients who hare undergone interrentional therapy.