使用体外循环切除浸润心脏结构的胸部恶性肿瘤。
Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass.
作者信息
Arif Rawa, Eichhorn Florian, Kallenbach Klaus, Seppelt Philipp, Ruhparwar Arjang, Dienemann Hendrik, Karck Matthias
机构信息
Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Department of Thoracic Surgery, Thoraxklinik Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
出版信息
J Cardiothorac Surg. 2015 Jun 25;10:87. doi: 10.1186/s13019-015-0296-8.
BACKGROUND
Only few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection. We aimed to investigate the early and late clinical outcome of these patients.
METHODS
Patients with thoracic malignancies that underwent surgery between 2002 and 2014 were analyzed. All patients had cardiopulomonary bypass support during resection. Clinical and perioperative data was retrospectively reviewed for outcome and overall survival.
RESULTS
Fifteen patients (12 female, mean age of 55 ± 15 years, range 24 to 80 years) were identified. Eleven (8 female) were diagnosed with primary thoracic malignomas and four with metastases. Three patients died early postoperatively. Patients diagnosed with sarcoma had a significantly worse outcome than non-sarcoma patients (83.3 ± 15.2 % after 1 year, 31.3 ± 24.5 % after 5 years vs. 83.3 ± 5.2 % after 1 year, 0 ± 0 % after 5 years, p = 0.005).
CONCLUSIONS
Malignancies with extension into cardiac structures or infiltration of great vessels can be resected with cardiopulmonary bypass support and tolerable risk. Carefully selected patients can undergo advanced operative procedures with an acceptable 1-year-survival, but only few patients achieved good long-term outcome.
背景
关于切除过程中需要体外循环的恶性胸段肿瘤的报道很少。我们旨在研究这些患者的早期和晚期临床结局。
方法
分析2002年至2014年间接受手术的胸段恶性肿瘤患者。所有患者在切除过程中均接受体外循环支持。对临床和围手术期数据进行回顾性分析以评估结局和总生存期。
结果
共确定了15例患者（12例女性，平均年龄55±15岁，范围24至80岁）。11例（8例女性）被诊断为原发性胸段恶性肿瘤，4例为转移性肿瘤。3例患者术后早期死亡。诊断为肉瘤的患者结局明显比非肉瘤患者差（1年后为83.3±15.2%，5年后为31.3±24.5%，相比之下，非肉瘤患者1年后为83.3±5.2%，5年后为0±0%，p = 0.005）。
结论
累及心脏结构或侵犯大血管的恶性肿瘤可在体外循环支持下切除，且风险可耐受。精心挑选的患者可接受先进的手术操作，1年生存率尚可，但只有少数患者能获得良好的长期结局。
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