左房黏液瘤合并二尖瓣返流的外科治疗

The surgical treatment of giant left atrial myxoma with mitral regurgitation

目的:总结术中发现二尖瓣返流的左房黏液瘤患者的相关临床资料,探讨其二尖瓣返流的临床特点、发生机制和处理方法。方法:2006年6月至2014年6月期间,因左房黏液瘤在温州医科大学附属第一医院行手术治疗的患者50例,其中切除肿瘤同期行二尖瓣手术的患者有10例。术者在切除肿瘤后常规对二尖瓣进行探查,术中应用食道心超对瓣膜情况进行评估,如发现存在中度以上的返流,则同期行二尖瓣成形术或者置换术。术后所有患者随访1年以上评估手术疗效。结果:10例同期行二尖瓣手术的患者在切除巨大肿瘤[长(5.0±1.9)cm,宽(4.1±1.0)cm]后发现均存在二尖瓣中重度返流,其中9例患者在术前检查中并未提示中度以上的二尖瓣返流。同期行二尖瓣成形患者9例,二尖瓣置换机械瓣1例,围手术期无死亡病例。随访期间无死亡、再次手术和肿瘤复发病例,未发现中度以上的二尖瓣返流。结论:对于行左房黏液瘤切除术的患者,特别是对于巨大黏液瘤的患者,在术中应警惕存在肿瘤切除后合并二尖瓣返流的可能,应在肿瘤切除后常规对二尖瓣进行探查,并且利用术中经食道心超及时动态地评估二尖瓣的功能情况,如发现存在严重的返流,推荐同期进行二尖瓣成形术。

Objective： To summarize our clinical data of left atrial （LA） myxoma patients with mitral regurgitation （MR） which found in surgery, in order to discuss the clinical characteristics, mechanism and treatment of MR. Methods： From July 2006 to July 2014, 50 patients were diagnosed with LA myxoma and underwent surgi- cal treatment at the First Affiliated Hospital of Wenzhou Medical University, which contained 10 cases who un- derwent tumor resection with mitral valve surgery. The surgeons should perform a careful inspection of the mitral valve after tumor resection and use intraoperative transesophageal echocardiography （TEE） to evaluate the mitral valve. If the dysfunction of leaflet or annular of mitral valve leads severe MR, the surgeons should perform mitral valve surgery after tumor resection. All patients were followed up more than 1 year to evaluate the outcomes of myxoma resection and mitral valve surgery and complications. Results： We found moderate to severe MR when the huge tumors [（5.0~1.9） cm ~ （4.1~1.0 cm）] were resected in 10 cases who underwent tumor resection with mitral valve surgery, severe MR was not mentioned in 9 cases before operation among them. We performed mi- tral valve reconstruction on 9 patients and mitral valve replacement on 1 patient. There was no operative death. During follow-up, there was no death, reoperation and myxoma recurrence, we also found 0 cases of moderate to severe MR. Conclusion： We suggested that the surgical team should be aware of LA myxoma with MR during the operation, especially the tumor is large. The surgeons should perform a careful inspection of the mitral valve and use TEE to detect the mitral valve dysfunction timely and evaluate the outcomes of operation. If the dysfunc- tion of leaflet or annular of mitral valve leads severe MR, we recommended the surgeons should perform mitral valve reconstruction firstly after tumor resection.