原发性心脏恶性肿瘤的手术疗效

Surgical outcomes of primary malignant cardiac tumours

目的:评估原发性心脏恶性肿瘤的手术治疗疗效,总结治疗经验。方法:回顾分析自2004年6月至2014年5月,于北京安贞医院接受手术治疗的23例原发性心脏恶性肿瘤病例的病例特点、手术治疗方法和随访资料,比较完整切除(A组,14例,3例术后失访,1例院内死亡)和姑息切除(B组,9例)的远期生存情况。结果:23例患者平均年龄(44.7±12.7)岁,男性12例,女性11例。肿瘤生长部位统计显示右心房肿瘤11例,右心室肿瘤2例,肺动脉肿瘤1例,左心房肿瘤9例。肿瘤病理分型包括血管肉瘤11例(47.8%)、平滑肌肉瘤4例(17.4%)、横纹肌肉瘤4例(17.4%)、黏液肉瘤4例(17.4%)、未分化肉瘤1例(4.3%)及恶性淋巴瘤1例(4.3%),手术病死率4.3%。总计随访284个月,最长66个月,最短1个月。A组术后平均生存时间为(38.2±9.1)个月,B组术后平均生存时间为[(4.1±1.2)个月,P=0.001]。结论:原发性心脏肿瘤罕见、侵袭力强、出现症状晚及完整切除肿瘤可延长患者生存时间。早期明确诊断,改进手术方法,提高完整切除比率,综合应用手术放化疗等治疗手段,可能改善患者预后。

Objective： To evaluate outcomes of surgical resection on primary malignant cardiac tumours and sumerize experience with treatments. Methods： Medical charts and follow-up data were reviewed on patients who suffer from primary malignant cardiac tumours and underwent surgical resection at Beijing Anzhen Hospital from June,2004 to May 2014. The long term outcomes were compared between complete resection group（ group A,14 cases,3 cases missed contacts after surgery,1 case died in hospital） and partial resection group（ group B,9 cases）. Results： 23 cases（ 12 males,11 females） were involved with a mean age of（ 44. 7± 12. 7） years. Tumours sites were right atrium in 11,right ventricle in 2,pulmonary artery in 1,left atrium in 9. Tumours histology were angiosarcomas in 11（ 47. 8%）,leiomyosarcomas in 4（ 17. 4%）,rhabdomyosarcomas in 4（ 17. 4%）,myxosarcomas in 4（ 17. 4%）,undifferentiated sarcoma in 1（ 4. 3%）,lymphoma in 1（ 4. 3%）. Operative motality was 4. 3%. Accumulated follow up time were 248 months,with maximal survival time of 66 months and minimal survival time of 1 month. Mean overal survival duration of group A was（ 38. 2 ±9. 1） months and was（ 4. 1 ± 1. 2） months of group B.（ P = 0. 001）. Conclusions： Primary malignant cardiac tumors are rare and with highly aggressive invasiveness,clinical symptoms appears late usually. Patients treated with a complete resection approach achieved longer survival duration. Early diagnosis,operative strategy improvement combine with multidisciplinary treatments including chemotherapy and radiotherapy are needed for achieving better results.