[原发性心脏肿瘤的诊断与外科治疗]

Jin Hai, Xu Zhi-yun, Yu Wei-yong, Wang Er-song, Zhang Bao-ren

Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.

Zhonghua Zhong Liu Za Zhi. 2006 Aug;28(8):609-11.

OBJECTIVE

To review and summarize the experience in diagnosis and surgical management of primary cardiac neoplasms.

METHODS

112 patients with primary cardiac neoplasms were treated surgically from Jan. 1980 to Jan. 2005. Those tumors were grouped into three categories: myxomas (98), benign nonmyxomas (3), and malignant tumors (11). Five of 11 malignant tumor patients underwent biopsy or palliative operation, the other patients received complete excision. Mitral valve replacement were done simultaneously in 2 of these patients, mitral valve repair in 4 and tricuspid valvoplasty in 33. All patients' diagnosis was confirmed by echocardiography.

RESULTS

108 patients survived the operation and 4 patients died postoperatively. The hospital mortality was 3.6% (4/112). Two patients developed poor left ventricular function postoperatively and died at the third and the seventh postoperative day due to low cardiac output. One patient developed and died of progressive hepatic and renal function failure postoperatively. Another one patient died of severe arrhythmia. Mean follow-up of 76 myxoma patients who are still alive was 6.4 years (range, 3 month to 17 years). Fifty-five patients still had heart function in New York Heart Association class I and 21 in class II at the end of follow-up without any evidence of recurrance. The follow-up results of benign nonmyxomas were similar to those of myxomas. Mean follow-up of all survived malignant tumor patient was 6 months (range, 2 months to 12 months). Ten of them died of recurrence or metastasis within 1 year postoperatively except only one still alive.

CONCLUSION

Surgical resection, whenever possible, is the first treatment choice for all kinds of primary cardiac tumors. Surgical resection of myxoma and benign nonmyxoma can give excellent long-term results which may lead to eventual cure of myxoma and benign nonmyxoma. For malignant tumor patient, surgical treatment is only palliative and to prolong the life of patients.

目的

回顾并总结原发性心脏肿瘤的诊断及外科治疗经验。

方法

1980年1月至2005年1月期间，112例原发性心脏肿瘤患者接受了手术治疗。这些肿瘤分为三类：黏液瘤（98例）、良性非黏液瘤（3例）和恶性肿瘤（11例）。11例恶性肿瘤患者中有5例接受了活检或姑息性手术，其他患者接受了完整切除。其中2例患者同时进行了二尖瓣置换，4例进行了二尖瓣修复，33例进行了三尖瓣成形术。所有患者的诊断均经超声心动图证实。

结果

108例患者术后存活，4例患者术后死亡。医院死亡率为3.6%（4/112）。2例患者术后出现左心室功能不全，分别于术后第3天和第7天因心输出量低死亡。1例患者术后出现进行性肝肾功能衰竭并死亡。另1例患者死于严重心律失常。对76例仍存活的黏液瘤患者的平均随访时间为6.4年（范围为3个月至17年）。随访结束时，55例患者的心功能为纽约心脏协会I级，21例为II级，无复发迹象。良性非黏液瘤的随访结果与黏液瘤相似。所有存活的恶性肿瘤患者的平均随访时间为6个月（范围为2个月至12个月）。其中10例在术后1年内死于复发或转移，仅1例仍存活。