71例心脏黏液瘤的临床诊断和治疗

Clinical diagnosis and treatment of 71 cases of cardiac myxoma

目的研究心脏黏液瘤的临床特点,总结外科手术经验。方法回顾性分析1989年12月～2005年5月在解放军总医院行手术治疗的71例原发性和复发性心脏黏液瘤患者,其中男性29例,女性42例,年龄40.12±12岁(12～63岁),所有患者术前均经超声心动图检查明确诊断,合并心脏病变术中一并纠治,切除的肿瘤组织常规行病理学检查。结果71例患者中左房黏液瘤66例(92.9%),右房黏液瘤3例(4.2%),右室黏液瘤1例(1.45%),左室黏液瘤1例(1.45%);3例患者(4.2%)黏液瘤为术后复发;6例患者(8.6%)有栓塞史。绝大多数左房黏液瘤的临床表现与二尖瓣狭窄类似,右房黏液瘤及右室黏液瘤患者出现右心功能不全症状,左室黏液瘤患者出现左室流出道狭窄症状并在主动脉瓣听诊区闻及收缩期喷射样杂音。合并冠状动脉病变2例,风湿性二尖瓣狭窄2例,二尖瓣中重度关闭不全3例,三尖瓣重度反流4例。手术均在体外循环下进行,手术死亡1例,术后反复复发1例,其余患者均恢复良好。所有患者病理学检查均证实黏液瘤病变。结论超声心动图可准确诊断心脏黏液瘤,一旦确诊,均应立即手术;心脏黏液瘤术后可复发,需长期随访。

Objective To study the clinical manifestations of cardiac myxoma and the morbidity, mortality and recurrence rate following surgery in our institution. Methods From December 1989 to November 2004, 71 patients underwent complete excision of primary or recurrent intracardiae myxoma. Pre-operative diagnosis was established by echo-cardiography. All patients underwent operation soon after the diagnosis of myxoma was made. Combined cardiac disorder was also treated synchronously. The excised myxoma was histopathologically studied routinely. Results Myxoma most commonly occurred in the fourth decade of life. Its commonest location （92. 9%） was the left atrium （LA）, but 3 patients had myxoma in the right atrium （RA）, one in the right ventricle （RV）, and one in the left ventricle （LV）. Patients with LA myxoma simulated mitral stenosis clinically, whereas patients with RA and RV myxoma presented features of right heart failure. Patients with LV myxoma had the symptoms of the left ventricular outlet tract obstruction. 6 patients had history of embolism. Combined cardiac diseases included coronary heart disease （2 cases）, rheumatic mitral stenosis （2 cases）, and severe mitral insufficiency （3 cases）, and severe tricuspid insufficiency （4 cases）. One patient had myxoma recurrence for three times after his first surgery, and died in the fourth operation. All the other patients survived the operation with the condition improved during the follow-up period. No late deaths were observed. Conclusions Echocardiography is the ideal diagnostic tool. Immediate surgical treatment is indicated in all patients. Cardiac myxoma can be excised with a low rate of mortality and morbidity. Close follow-up for detecting recurrence is necessary.