127例原发性心脏肿瘤的外科治疗及疗效分析

Surgical Treatment and Curative Effect of 127 Primary Cardiac Tumours

目的:总结原发性心脏肿瘤的诊断及外科治疗经验。方法:回顾性分析127例原发性心脏肿瘤的临床特点及诊治结果。结果:1988年9月～2004年1月共收治127例心脏肿瘤患者,占同期所有体外循环手术的2.48%(127/5128)。其中男性44例,女性83例。年龄10个月～72岁,平均(39.89±16.75)岁。通过超声心动图了解肿瘤位置和瓣膜功能情况。围手术期总死亡率8.66%(11/127)。良性肿瘤组死亡率为6.03%(7/116),恶性肿瘤组死亡率为37.5%(3/8)。两组死亡率有明显差别(P<0.05)。60岁以下患者113例,死亡7例(6.19%),60岁以上(包括60岁)14例,死亡3例(21.43%)。两组患者死亡率无差别(P>0.01)。出院病人116例,随访97例(83.62%),随访时间3个月～15.3年。其中粘液瘤复发8例,复发次数为1～3次,复发时间间隔1年～15年,平均(4.77±4.57)年。结论:原发性心脏肿瘤临床表现复杂多样,超声心动图对其有独特的诊断价值和优越性,手术摘除肿瘤为首选的治疗方法。其预后主要取决于肿瘤的病理类型及肿瘤是否为多源性生长。

Objective: To review the diagnosis and surgical treatment of primary cardiac tumors. Methods: The clinical features and surgical results in 127 patients of primary cardiac tumors were analyzed retrospectively. Results: Between September 1988 and January 2004, one hundred and twenty-seven patients with primary cardiac tumors underwent surgical treatment by the aid of general anesthesia and cardiopulmonary bypass, comprising 2.48 %( 127/5128) of all open-heart operation. Forty-four patients were male and 83 female. Age ranged from 10 months to 72 years old (mean±standard 39.89±16.75years). The perioperative mortality was 8.66%(11/127). The mortality of benign tumors and malignant tumors was 6.03% and 37.5% respectively. The difference between them was significant (P<0.05). One hundred and sixteen patients were discharged from hospital and 97 cases were followed-up for 3 months to 15.3 years. Eight patients with myxoma recurred 1 to 3 times. The mean recurrence time was (4.77±4.57) years. Conclusions: The clinical findings of primary cardiac tumor are diverse and complex. The echocardiography is particular and predominant for the diagnosis, and the surgical treatment is the first choice. The prognosis of the cardiac tumors is mainly determined by the histopathological type and whether they grow multicentrically.