摘要
目的:回顾性总结原发性心脏肿瘤103例的外科治疗效果。方法:根据病检结果分类,103例中良性肿瘤97例,占94.2;恶性肿瘤6例,占5.8。本组病例术前均行心脏彩超,怀疑恶性者行CT或核磁共振检查。所有良性肿瘤中,除1例平滑肌瘤由下腔静脉延伸至右房,仅部分切除外,其余均完全切除。同期行Dacron补片房间隔修补74例,三尖瓣瓣膜置换1例,二尖瓣整形6例,三尖瓣整形1例,同期行冠状动脉搭桥2例。恶性心脏肿瘤患者中,2例血管肉瘤患者,1例完全切除肿瘤,同期行右房-房间隔重建并行右房-上腔静脉人工血管连接术,并在术后接受局部放疗,另1例行部分切除及自体心包右心房修补;2例右室横纹肌肉瘤患者,行部分肿瘤切除术;2例肺动脉恶性间皮瘤累及肺动脉患者,在体外循环下经肺动脉切口清除肿瘤,疏通肺动脉直至肺门水平。结果:住院期间,全组仅死亡1例,其余患者均顺利出院。良性肿瘤在(2±1.7)年随访期内未发现复发者。6例恶性肿瘤患者中5例术后6个月内早期复发。结论:原发性心脏肿瘤的治疗应根据其恶性程度、来源、侵犯范围、大小来决定手术时机和方式;心脏良性肿瘤中最常见的是黏液瘤,手术应及时进行。发热及血沉增快并不是手术禁忌;术中应防止瘤体破碎,避免遗留肿瘤组织,应切除瘤蒂附着的房壁、房间隔甚至部分瓣膜,防止复发;心脏原发恶性肿瘤预后不良,往往难以完全切除,术后应辅以化疗或放疗。
Objective：To review the surgical treatment of 103 patients with primary cardiac tumors in wuhan Union hospital from 1994 to 2007. Method：In the 103 patients, 45 were male, 58 were female. Age 17-78（42.8± 12.3） years. Weight （50±8.60） kg. The 97 patients were suffering benign tumors, 6 were malignant. All patients received ECG examinations. Patients who were supposed suffering malignant tumors were exanimate by CT or MRI. All benign tumors were totally excised except one patient with leiomyoma growing into right atrial through inferior vena. 74 patients got ASD repaired. 1 got tricuspid valve replacement, 6 got mitral valve repair, 1 got tricuspid v valve repair,and 2 got CABG operations. Six malignant tumors got surgery treatment. The two right ventricular rhabdomyosarcoma got partial resection. In the two angiosarcoma tumor, one got complete resection and right atrial rebuilded, the superior vana cava and right atrial were connected with conduit; the other got partial resection and right atrial repairing with pericardium. Two malignant mesotheliomas, with the aid of the CPB, were excised as much as possible to the level of hilus pulmonis to release the complaint of chronic pulmonary embolism. Result：One patient with myxoma died after operation. There were no recurrences in benign tumors. 5 in 6 patients with malignant tumor recurrented, 4 died in 6 months after operation. Conclusion： The treatment of the heart tumor should decided by pathology type, origination, encroachment range, and tumor size. Myxoma is the most common benign tumor, and should be treated in time. Fever and increased erythrocyte sedimentation rate is not the contradiction. In the operation, the tumor should be excised as completely as possible, even by excise part of the atrial septal or valve. The primary cardiac malignant tumor got unfavorable prognosis. In fact it is difficult to perform complete resection. Radiotherapy or chemotherapy may need for these patients.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2008年第11期829-832,共4页
Journal of Clinical Cardiology
关键词
心脏肿瘤
手术治疗
Cadiac tumor
Surgical treatment
