129例原发心脏肿瘤的临床分析

Primary cardiac tumors:clinical analysis of 129 patients

目的探讨原发心脏肿瘤的临床特点和手术经验。方法回顾分析本院1980-2009年8月手术治疗129例原发心脏肿瘤。其中,男性38例,女性91例,年龄1～75岁。病程1个月至12年,临床症状为劳力性心累、气促,低热,贫血,肢体栓塞等。术前均经超声心动图明确诊断,除2例肉瘤患者开胸探查,未进行切除外,其余均在全身静脉复合麻醉体外循环下行手术切除,术中采用冷晶体停搏液、冷血停搏液和心脏不停跳等心肌保护方法。患者术后均进行病理检查。结果本组黏液瘤最常见,共117例(90.70%),其中左心房黏液瘤105例,右心房黏液瘤8例,二尖瓣体黏液瘤2例,多发性黏液瘤2例;横纹肌瘤6例,脂肪瘤1例,毛细血管瘤2例,平滑肌瘤1例,肉瘤2例。手术患者早期死亡1例,死因为低心排综合征,开胸探查肿瘤不能切除2例,其余均痊愈出院。手术后随访2个月至10年,恢复良好,无复发患者。结论原发心脏肿瘤以心脏黏液瘤最常见,心脏黏液瘤诊断明确应急诊或亚急诊手术。其他类型原发心脏肿瘤诊断明确仍应积极手术,术后心脏功能多有改善。

Objective To investigate the clinical features and summarize our experience of surgical treatment in primary cardiac tumors.MethodsClinical data of 129 patients with primary cardiac tumors admitted in our center from 1980 to August 2009 and underwent surgical treatment were analyzed retrospectively.Their age ranged from 1 year to 79 years,38 of them were males,and the course of disease was from 1 month to 12 years.The clinical symptoms included tachypnea after exertion,low-grade fever,anemia,embolism limb,and so on.The diagnosis was identified by echocardiography pre-operation and by pathological test post-operation.One hundred and twenty-seven of them underwent tumorectomy through extracorporeal circulation.The cold crystal cardioplegia solution,cold blood cardioplegia solution,and on-pump beating heart were used to protect the myocardium during operation.The left 2 patients with cardiac-sarcoma were operated on with exploratory thoracotomy.ResultsThe primary cardiac tumors in this group included 117 myxoma（105 left atrial myxoma,8 right atrial myxoma,2 mitral valve myxoma,and 2 multiple myxoma）,6 rhabdomyoma,1 lipoma,2 capillary hemangioma,1 leiomyoma,and 2 sarcoma.One patient was dead of low cardiac output syndrome in 3 d post-operation.The rest 128 were discharged with no any complication.There was no death and recurrent of cardiac tumor during a follow-up of 2 months to 10 years in tumorectomy group.ConclusionCardiac myxoma is most common in primary cardiac tumors,and emergency or subemergency operation should be performed as soon as the diagnosis is made.The other types of primary cardiac tumors need to be operated,and significant improvement of heart function will be obtained after surgery.