经皮肺动脉瓣球囊成形术与外科治疗单纯性肺动脉瓣狭窄的对比研究

目的　探讨经皮肺动脉瓣球囊成形术 (PBPV)替代外科手术治疗单纯性肺动脉瓣狭窄(IVPS)的可行性。方法　外科组包括 3 1例IVPS患者 ,PBPV组为同期接受PBPV的 14 6例IVPS患者。比较 2种方法的疗效和费用等情况。结果　PBPV组技术成功率为 10 0 % ,无严重并发症发生 ;外科组3 1例全部手术成功 ,无死亡 ,术后出现中量胸腔积液 2例 ,肺不张 1例 ,气胸 1例 ,重度三尖瓣关闭不全 1例。两组间术前、术后及随访中的肺动脉瓣跨瓣压差 (PG)值无显著性差异 ;两组的平均总费用相似 (P >0 .0 5) ,但西药费外科组显著高于PBPV组 ,器材费PBPV组明显高于外科组 (均P <0 .0 5)。结论　PBPV术疗效与外科手术相当 ,但较外科手术有更好的效价比 ,更易被患者所接受 ,PBPV术可以替代外科手术 ,成为治疗IVPS的首选方法

Comparative study on the treatment of isolated valvular pulmonary stenosis between percutaneous balloon pulmonary valvuloplasty and surgical valvulotomy

Objective To evaluate the feasibility of treatment of isolated valvular pulmonary stenosis (IVPS) by percutaneous balloon pulmonary valvuloplasty(PBPV) instead of surgical valvulotomy. Methods The surgery group included thirty-one patients (16 males, 15 females) treated by surgical valvulotomy, and the PBPV group included one hundred and forty-six patients (75 males, 71 females) treated by PBPV during the same period. The effectiveness and cost of both methods were compared. Results The technical successful rate of both methods was 100%. There were no severe complications in PBPV group; The major complications in surgical group included middle pleural effusion in 2 patients, atelectasis in 1 patients, pneumothorax in 1 patients, severe tricuspid regurgitation in 1 patients, respectively. The pulmonary stenosis gradients (PG) in pre-procedure, post-procedure, and follow-up had no significant difference respectively between the two groups( P >0.05). The mean total cost in both groups was similar( P >0.05), but the mean drug cost of surgical group was much higher than that of PBPV group while the mean material cost of PBPV group was significantly higher than that of surgical group( P <0.05). Conclusion PBPV would be the first choice to cure IVPS instead of surgical valvulotomy.