心脏黏液瘤的外科治疗体会

Surgical treatment of cardiac myxoma.

目的总结心脏黏液瘤的诊断及外科治疗体会。方法回顾性分析山东大学齐鲁医院1990年1月至2007年5月收治的127倒及厦门心脏中心近4年所收治的6例心脏黏液瘤患者临床资料。术前均经二维超声心动图明确诊断，其中肿瘤位于左心房109例、右心房22例、双心房2例。均在体外循环下取胸部正中切口，经右心房-房间隔途径摘除黏液瘤。同期行二尖瓣成形术11例，三尖辫成形术6例。切除肿瘤均送检病理。结果术后早期因严重低心排血量综合征死亡2例，术后新发脑栓塞6例，左下肢栓塞1例，肺栓塞1例。余患者术后未出现严重并发症，自觉症状较术前明显好转，心脏体征消失，痊愈。病理检查结果均显示为心脏黏液瘤。结论心脏黏液瘤多为良性，但引起的临床后果严重，一经诊断应尽早手术摘除；术中严防肿瘤脱落是手术成功的关键，且应注意术后随访；二维超声心动图是诊断心脏黏液瘤的最佳方法。

Objective To review and sum up the experience of diagnosis and surgical treatment of cardiac myxoma. Methods 133 patients with cardiac myxoma of different locations from January 1990 to May 2007 admitted in Qilu Hospital of Shandong University and Department of Cardivovaseular Affdiafed Zhong sban Hospital of Xiamen Unversity were clearly diagnosed by two dimensional echocardiography. The tumors of 109 patients were located in left atrium ,22 in right atrium and 2 in both cardiac atria. All the patients underwent tumor extirpation under extracorporeal circulation. Atrioventricular valve plasty was performed when necessary. 11 underwent bicuspid valvuloplasty and 6 underwent tricuspid valvuloplasty at the same time. All the tumors were sent to histopathology examination. Results Two patients died of low cardiac output syndrome in early postoperative period. Cerebral embolism happened in 6 cases,left lower extremity embolism and pulmonary embolism in 1 case respectively. Other patients＇ symptoms were improved and the physical sign disappeared. All the tumors were demonstrated to be benign cardiac myxoma. Conclusions Most cardiac myxoma is benign but its clinical consequence is severe. So tumor extirpation should be performed as soon as possible and the following-up is important after operation. Prevention of tumor defluvium is important. Two dimensional echocardiography is preferred in the diagnosis of cardiac myxoma.