16例儿童原发性心脏肿瘤的疗效分析

Surgical treatment for primary pediatric cardiac tumors

目的总结儿童原发性心脏肿瘤的治疗效果。方法收集2003年6月30日至2017年5月2日由本院确诊并行手术治疗的原发性心脏肿瘤患儿作为研究对象,回顾性分析患儿的年龄分布、临床表现、肿瘤部位、诊断、治疗、病理分型及预后等情况。结果 16例原发性心脏肿瘤患儿中,男童4例,女童12例;年龄范围为1.3个月至12.5岁,平均年龄为2.45岁;临床表现多以胸闷、气促为主;14例为单发肿瘤,2例为多发肿瘤;肿瘤位于左心房4例,左心室2例,右心房4例,右心室4例,室间隔2例;患儿均行心脏彩超检查,其中8例行心脏MRI检查,1例行CTA检查;12例心脏肿瘤完整切除,3例心脏肿瘤部分切除;1例行心脏肿瘤活检术;术后病理学诊断黏液瘤8例,纤维瘤3例,横纹肌瘤2例,婴儿型毛细血管瘤、脂肪瘤、脂肪母细胞瘤各1例。5例失访,11例随访3个月至6年,未出现肿瘤复发或肿瘤继续增长。结论儿童原发性心脏肿瘤症状不典型,多在婴幼儿期诊断,心脏彩超是首选检查方法,部分需行心脏MRI检查,对有明显症状者应及时采取手术治疗,手术以恢复正常血流动力学状态为目的,可根据病变位置及大小选择行完整切除或部分切除,治疗效果良好。

Objective To summarize the experiences of diagnosing and treating primary cardiac tumors in children. Methods From 2003 to 2017,16 surgical cases of primary cardiac tumor were recruited and ret-rospective analyses performed for age distribution,clinical manifestations,tumor locations,diagnoses,treatment, pathologic classifications and prognoses. Results There were 4 boys and 12 girls aged from 1. 3 months to 12. 5 years. The major clinical manifestations included chest tightness and shortness of breath. In 14 cases,only one tumor were present while another other 2 cases had multiple tumors. Tumors were located in left atrium （ n =4） , left ventricle （ n =2） 9right atrium （ n = 4 ） , right ventricle （ n = 4） and ventricular septum （ n = 2 ） . This group was examined by color echocardiography. Among them,8 patients received cardiac MRI examination while another routine computed tomography angiography （CTA）. Resection was total { n = ／2 ） and partial （ n = 3 ） . One case received cardiac tumor biopsy. The results of postoperative pathology examination were as follows： myxoma （= 8） ,fibroma （re = 3） ,rhabdomyoma （ n = 2 ） and infantile capillary hemangioma, lipoma ＆ lipo- blastoma （n = 1）. Five cases were lost and 11 cases followed up for 3 months to 6 years. There was no recur-rence or tumor growth. Conclusion Primary pediatric cardiac tumors have a low incidence and atypical symp-toms. They are more frequently diagnosed in infants. Color echocardiography and MRI or CTA confirm a diagno-sis. Those with obvious symptoms should be operated promptly for restoring normal hemodynamics. Complete re- section or partial resection should be chosen according to the location and size of lesion.