摘要
目的探讨累及心脏的静脉内平滑肌瘤病的诊断方法及治疗效果。方法收集自2009年3月至2018年12月兰州大学第一医院确诊累及心脏的静脉内平滑肌瘤病患者5例。均以右心房占位性病变收入院,查找病历,记录其超声心动图、CT及MRI等相关资料,分析并总结患者术前诊断、手术方式及治疗效果。结果5例患者均为女性,年龄为(45.8±2.2)岁,临床表现为不同程度的胸闷、气短,3例合并有巨大子宫肌瘤病史。均行超声心动图,其中3例有明显向下腔延续。手术建立体外循环,行胸腹联合切口,5例患者瘤体完全切除,其中3例肿瘤起源与MRI检查结果一致。3例肿瘤起源于右侧子宫静脉,2例起源于右侧卵巢静脉并行股静脉插管。手术顺利,术后恢复良好,均顺利出院。随诊1年,盆腔、下腔静脉及心脏内无肿瘤复发。结论累及心脏的静脉平滑肌瘤病在临床上少见且易误诊,多以至右心房占位为首诊,术前可通过心脏彩超、CT及MRI等方法提高诊断。手术应根据术中所见及不同的起源调整术式,尽量完全切除肿瘤,必要时联合妇科会诊。短期随访预后良好。
Objective To investigate the diagnosis and treatment of intravenous leiomyomatosis involving the heart.Methods From March 2009 to December 2018,5 patients with intravenous leiomyomatosis with cardiac involvement were collected from The First Hospital of Lanzhou University.All patients were admitted to the hospital as space occupying lesions of right atrium.The relevant data such as echocardiography,CT and MRI were recorded.The preoperative diagnosis,surgical methods and therapeutic effect of the patients were analyzed and summarized.Results All the 5 patients were female with an average age of(45.8±2.2)years old.Their clinical manifestations were chest tightness and shortness of breath.Three patients had a history of giant hysteromyoma.Echocardiography was performed in all patients,and 3 of them obviously extended to the inferior chamber.Cardiopulmonary bypass was established and thoracoabdominal incision was performed,and the tumors were completely resected in 5 patients,and the origin of tumors was consistent with the result of MRI in 3 cases.The tumor originated from the right uterine vein in 3 cases,and 2 cases originated from the right ovarian vein and was intubated in the femoral vein.The operation was smooth and the postoperative recovery was good.All patients were discharged smoothly.No tumor recurrence was found in pelvic cavity,inferior vena cava and heart after 1 year follow-up.Conclusion Venous leiomyomatosis involving the heart is rare and easy to be misdiagnosed.Most of them are diagnosed as right atrial space occupying lesions.The diagnosis can be improved by echocardiography,CT and MRI before operation.The operation mode should be adjusted according to the intraoperative findings and different origins,and the tumor should be completely removed as far as possible,and combined with gynecology consultation if necessary.The short-term follow-up showed good prognosis.
作者
程殿威
刘世栋
赵志宇
宋兵
Cheng Dianwei;Liu Shidong;Zhao Zhiyu;Song Bing(Department of Cardiovascular Surgery,The First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《中国综合临床》
2020年第5期465-468,共4页
Clinical Medicine of China
关键词
静脉内平滑肌瘤
右心房占位
心脏肿瘤
诊断
治疗
Intravenous leiomyomatosis
Right atrium occupation
Heart tumor
Diagnosis
Treatment
