摘要
目的回顾性总结原发性心脏肿瘤外科切除的手术方法和经验,分析其临床疗效和随访结果。方法自2005年1月至2019年9月,于广东省高州市人民医院就诊的原发性心脏肿瘤患者149例,术前经超声心动图检查确诊,接受全麻体外循环下肿瘤切除手术,均采用胸骨正中切口直视下手术,完全切除148例,部分切除1例。同期行二尖瓣成形术21例,三尖瓣成形术14例,房颤射频消融4例,冠状动脉旁路移植术2例,二尖瓣置换术1例。术中行经食道超声心动图评价手术切除效果和瓣膜功能,术后常规病理检查明确肿瘤类型。结果住院期间,全组患者死亡1例,右室肉瘤患者术后并发低心排综合征第5 d死亡,其余均顺利康复出院。病理检查示良性肿瘤145例(97.32%),恶性肿瘤3例(2.01%),交界性肿瘤1例(0.67%)。134例随访2个月~14年,失访15例,良性肿瘤均未复发,随访生存良好。2例右室肉瘤分别于术后7个月、1年1个月复发,术后11个月、1年3个月死亡。结论原发性心脏肿瘤首选外科手术切除,高龄、心功能不全并非禁忌症,临床疗效取决于病理类型和手术时机。良性肿瘤预后好,把握手术时机和加强围手术期管理可提高手术成功率和减少并发症。恶性肿瘤易复发,预后不良。
Objective To retrospectively summarize the surgical methods and experience of surgical resection of primary cardiac tumors,and to analyze its clinical efficacy and follow-up results.Methods From January 2005 to September 2019,149 patients with primary heart tumors in Gaozhou People's Hospital were diagnosed by echocardiography before surgery and underwent tumor resection under general anesthesia with extracorporeal circulation.All were operated under the direct view of the sternum median incision.148 cases were completely excised and 1 case was partially excised.In the same period,21 cases of mitral valvuloplasty,14 cases of tricuspid valvuloplasty,4 cases of atrial fibrillation radiofrequency ablation,2 cases of coronary artery bypass grafting,and 1 case of mitral valve replacement were performed.Transesophageal echocardiography was performed during the operation to evaluate the surgical resection effect and valve function,and the tumor type was determined by routine pathological examination after the operation.Results During hospitalization,one dead patient died on the fifth day after the operation of right ventricular sarcoma patients with low cardiac output syndrome,and the rest were discharged smoothly.Pathological examination revealed 145 cases of benign tumors,accounting for 97.32%,3 cases of malignant tumors,accounting for 2.01%,and 1 case of borderline tumors,accounting for 0.67%.134 cases were followed up for 2 months to 14 years,and 15 cases were lost to follow-up.None of the benign tumors recurred.The follow-up survival was good.Two cases of right ventricular sarcoma recurred at 7 months,1 year and 1 month after operation,and died 11 months and 1 year and 3 months after operation.Conclusion Surgical resection is the first choice for primary cardiac tumors.Older age and cardiac insufficiency are not contraindications.The clinical efficacy depends on the pathological type and timing of surgery.Benign tumors have a good prognosis,grasping the timing of surgery and strengthening perioperative management c
作者
刘浪
曹勇
陈凯明
赖锋华
Liu Lang;Cao Yong;Chen Kaiming;Lai Fenghua(Department of Cardiovascular Surgery,Gaozhou People's Hospital,Guangdong 525200,China;不详)
出处
《中国循证心血管医学杂志》
2020年第5期558-560,565,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
广东省茂名市科技计划项目(2017090)。
关键词
原发性心脏肿瘤
外科治疗
疗效
Primary cardiac tumor
Surgical treatment
Curative effect
