心脏黏液瘤65例诊断和外科治疗

Diagnosis and surgical treatment for 65 cases with cardiac myxomas

目的:总结65例心脏黏液瘤的诊断和外科治疗经验,以提高疗效。方法:65例心脏黏液瘤患者均在全麻体外循环下行黏液瘤摘除术,其中44例阻断主动脉,21例仅阻断上、下腔静脉,在心脏跳动下进行手术;右心房黏液瘤经右心房切口入路,左心房黏液瘤经右心房、房间隔入路;缺损房间隔用涤纶补片缝合31例,余直接缝合;同期行三尖瓣成形术5例,二尖瓣成形术1例。结果:患者术前均经超声心动图检查确诊,并经手术及病理证实,经治疗后均痊愈出院,随访3个月至15年,心功能恢复至NYHAⅠ级63例,Ⅱ级2例。手术2年后,复发1例,经二次手术后治愈,复发率为1.54%。结论:超声心动图是诊断心脏黏液瘤简便、有效的方法,一经确诊应尽早手术,彻底切除是防止复发的关键,要加强术后随访。

Objective： To summarize the experience of diagnosis and surgical treatment in 65 cases with cardiac myxomas for improving the curative effects. Methods：The cardiac myxomas were resected all 65 cases under cardiac pulmonary bypass anesthesia. Under the condition of heartbeat,the aortas of 44 eases and superior ＆ inferior vena of 21 cases were blocked, The operation paths of cardiac myxomas location in right atrium and left atrium were through right atrium and right atrium ＆ atrial septum, respectively. The atrial septal defects of 31 cases were sutured by dacron patch and other cases were sutured directly. Tricuspid and mitral valve plasty were performed in 5 and 1 patients, respectively. Results： All patients were diagnosed by echoeardiography in preoperation, confirmed by the surgery and pathology and discharged from hospital after recovery. The heart function of 63 and 2 cases were recoverd to NYHA I and I1 ,respectively,during the period of the follow-up for 3 months to 15 years. One case with cardiac myxomas recurred 2 years after surgery, who was cured through the second operation. The recurrence rate was 1.54%. Conclusions： Eeocardiography is an effective and simple way to diagnose the cardiac myxomas. The early operation as soon as possible and radical resection are the key to prevent recurrence and postoperative follow-up must be reinforced.