原发心房肿瘤超声心动图图像特征及规律性研究(附200例病理对照和术后随访)

Study on imaging characteristics and regularity of the echocardiography of primary atrial tumors(with pathological correlation and postoperative follow-up of 200 cases)

目的:探寻原发心房肿瘤超声心动图(ECG)图像特征及规律性,观察心房肿瘤ECG图像特征与病理和预后关系。方法:应用ECG检查200例原发心房肿瘤,探寻心房肿瘤ECG图像特征及规律性,所有病例均经手术和病理证实,术后ECG随访。结果:根据ECG图像特征对200例心房肿瘤全部做出正确诊断。心房肿瘤ECG图像特征及规律性明显:①左房肿瘤多见,右房肿瘤少见,双房肿瘤罕见。②左房肿瘤以粘液瘤多见,ECG图像表现单一,其它肿瘤少见;右房肿瘤虽然少见,但肿瘤病理类型多,ECG图像特征多样。③粘液瘤与心房壁界限明显,绝大多数都通过短蒂与房间隔相连,极少数与心房壁相连,瘤体以蒂为固定点随心脏收缩、舒张往返运动;恶性肿瘤与心房壁接触密切,接触范围广泛,无蒂,瘤体不随心脏收缩、舒张运动。④心房粘液瘤可致房室瓣相对性狭窄和关闭不全,但一般不引起瓣膜器质性病变,瘤体摘除后ECG随访绝大多数房室瓣功能即恢复正常。⑤术后ECG随访粘液瘤术后复发率很低,复发间隔时间较长;恶性肿瘤复发率很高,复发间隔时间很短。结论:原发心房肿瘤ECG图像特征及规律性明显,ECG对原发心房肿瘤有特异性诊断价值,但最后确定肿瘤性质必须依靠病理诊断。

Objective： To investigate the echocardiographic（ECG） characteristics and regularity of primary atrial tumors and observe the ECG characteristics for primary atrial tumors with its pathological results and prognosis. Methods： Two hundred patients with primary atrial tumor underwent ECG examination, the results of which were proved by operation and pathological examination. The patients were followed up. Results： Two hundred patients were correctly diagnosed, according to the ECG characteristics, as having primary atrial tumors. It was demonstrated in the ECG as follows：① most tumors developed in left atrium, few in right atrium and infrequent in both atriums; ②most tumors in left atrium were myxoma, of which the appearance is simple in ECG image. Fewer tumors developed in right atrium, but they had more pathological types, which had various shapes in ECG image; ③myxoma had obvious boundary with atrial wall, most of which connected with atrial septum by short pedical and few connected with atrial wall directly. The tumor body shuttled with systole and diastole of heart around the pedical. Malignant tumors connected with atrium wall tightly and broadly without pedical, and did not move with the systole and diastole of heart; ④atrial myxoma led to relative atrioventricular valves stenosis or insufficiency, but it seldom led to organic change of valve. Most patients recovered with normal function of atrioventricular valves by follow up with ECG after extirpating the tumor; ⑤myxoma had lower recurrence rate and longer recurrence interval, and malignant tumor had higher recurrence rate and shorter recurrence interval. Conclusion： The feature of ECG image in primary atrial tumor was obvious. ECG was valuable in diagnosing especially primary atrial tumor, but only pathological diagnose could decide the type of tumor.