60岁以上患者心脏肿瘤的外科治疗

Surgical treatment of patients with cardiac tumors beyond 60 years of age

目的探讨老年人心脏肿瘤的外科治疗特点。方法自1980年1月至2004年12月间,我院对35例年龄＞60岁的老年原发性心脏肿瘤患者施行体外循环下的肿瘤切除术,男14例,女21例；年龄62～74岁。良性肿瘤32例,其中黏液瘤30例、脂肪瘤和纤维瘤各1例；恶性肿瘤共3例。结果所有患者均在全麻体外循环下行肿瘤切除术,术后早期有2例因出现严重低心排综合征和室性心律失常而死亡,死亡率为5．71%(2/35例)。结论老年心脏肿瘤患者的心功能较差,心律失常发生率高,术中易发生心房破裂,且多合并有冠心病或其他老年性疾病。了解并掌握其特点,对改进手术方法、提高围手术期处理能力及手术成功率有着重要的临床意义。

Objective To appraise the characteristics of surgical treatment for cardiac tumors in the elderly. Methods From January 1980 to December 2004, 35 aged patients greater than 60 underwent operation for primary cardiac tumors with cardiopulmonary bypass. 14 males and 21 females with age range of 62 to 74 years. Among these cases, 32 were benign tumors including 30 myxomas, 1 lipoma and 1 fibroma; and 3 malignant tumors. Results All the patients received surgical resection of the tumors under cardiopulmonary bypass and general amesthesia. Two died perioperatively, due to severe low output syndrome（I） and ventricular arrhythmia（1）. The mortality rate was 5. 71%. Conclusion Aged patients with cardiac tumor always complicate with coronary heart diease, impaired heart function, higher incidence of arrhythmia and easy intraoperative atrium rupture. Improving the successful management, operative skill and the ability of perioperative care are the salient points to be handled.