外科治疗心脏肿瘤40例临床分析

Clinical analysis of 40 cases of cardiac neoplasm

目的：总结40例心脏肿瘤的临床特征和外科治疗经验。方法回顾性分析我院2010年4月至2014年4月间经超声心动图确诊、外科手术治疗的40例心脏肿瘤患者的临床资料，着重分析肿瘤的性质、分布、临床表现和治疗方法及转归。结果本组良性粘液瘤39例（97．5％），恶性肿瘤1例（2．5％）；男性12例（30．0％），女性28例（70．0％）；肿瘤位于左心房38例（95．0％），右心房2例（5．0％）。正中开胸手术切除肿瘤37例，电视胸腔镜下切除肿瘤2例，恶性肿瘤未能切除1例，手术切除率97．5％。围手术期死亡患者1例（2．5％），死于肺栓塞；1例原发性恶性肿瘤患者术后6个月死亡；其余患者临床症状消失，心功能恢复至Ⅰ级，随访2个月～4年，均无复发。结论本组心脏肿瘤中多为左心房良性黏液瘤，女性多见；外科手术彻底摘除瘤体是治疗心脏肿瘤的主要手段，电视胸腔镜手术可作为治疗左房粘液瘤安全有效的微创术式。

Objective To summarize the clinical characterizations and surgical treatment of primary cardiac neoplasm.Methods From April 2010 to April 2014, we received a total of 40 cases of cardiac neoplasm confirmed by echocardiography .Retrospective analysis of clinical data in these 40 cases, focusing on analysis of the nature of the tumor, distribution, clinical manifestations, treatment and prognosis.Results There were 12 male （30.0%） patients and 28 females （70.0%） in all these cases, including 39 patients with myxomas （97.5%） and 1 patient with malignant tumors （2.5 %）.We find tumor in the left atrium of 38 patients （95.0%） and in right atrium of 2 cases （5.0%）.There were 37 cases of median sternotomy resection and 2 cases of thoracoscopic resection .39 patients underwent completely removal of the tumors （97.5%）, remaining 1 patient received exploratory thoracotomy only .Other procedures had done in the same stage including 1 case with mitral valvuloplasty.In the perioperative period 1 case （2.5%） died of pulmonary embolism;1 case of primary malignant tumor patients died within 6 months.All other patients were cured after treatment and were followed up for 2 months to 4 years,no recurrence.Conclusions The group of cardiac tumors are mostly benign left atrial myxoma, more common in women.Thorough surgical removal of the tumor is the primary means of treatment of cardiac tumors .Surgical treatment is effective for the benign cardiac tumors .Video-assisted thoracoscopic surgery is safe and effective for left atrial myxoma treatment .