左心房黏液瘤患者瘤体质量与心功能、肺动脉压的关系及术后病理学观察

Relationship among tumor mass, heart function and pulmonary arterial hypertension(PAH) and postoperative pathological observation in patients with left atrial myxoma

目的探讨左心房黏液瘤患者的瘤体质量与心功能、肺动脉压的关系及术后病理学观察。方法回顾性分析2013年7月~2016年7月于济宁医学院附属医院诊治的57例左心房黏液瘤患者资料,其中男性38例,女性19例,年龄34~83岁。根据纽约心脏协会(NYHA)心功能分级分为4组:Ⅰ级(9例)、Ⅱ级(19例)、Ⅲ级(22例)、Ⅳ级(7例)。所有患者手术治疗前后测定左室射血分数(LVEF)、左室舒张末内径(LVEDD)、肺动脉压水平,HE染色观察心脏黏液瘤。结果随着NYHA分级增高,患者心脏黏液瘤的瘤体质量也呈增加的趋势,差异均具有统计学意义(P均<0.05)。术前各组随着NYHA分级增高,LVEF值呈降低趋势,LVEDD以及肺动脉压呈升高趋势,差异有统计学意义(P均<0.05)。各组患者术后3个月LVEF值均较术前升高,LVEDD及肺动脉压较术前降低,差异有统计学意义(P均<0.05)。心脏黏液瘤患者的瘤体质量与患者手术前的LVEF呈显著负相关(r=-0.497,P<0.001),与LVEDD及肺动脉压水平呈正相关,相关系数分别为0.553和0.572(P均<0.01)。瘤体病理学观察可见较多的血管及肿瘤细胞浸润。结论左心房黏液瘤患者瘤体质量与其心功能、肺动脉压密切相关;手术治疗可改善患者的心功能和肺动脉压。

Objective To investigate the relationship among tumor mass,heart function and pulmonary arterial hypertension(PAH)and postoperative pathological observation in patients with left atrial myxoma.Methods The data was retrospectively analyzed in the patients(n=57,male38,female19and aged from34to83)treated in the Affiliated Hospital of Jining Medical College from Jul.2013to Jul.2016.All patients were divided,according to the grading of New York Heart Function Assessment(NYHA),into grade I group(n=9),grade II group(n=19),grade III group(n=22)and grade IV group(n=7).The levels of left ventricular ejection fraction(LVEF),left ventricular end-diastolic inner diameter(LVEDd)and PAH were detected,and cardiac myxoma was observed after HE staining in all patients before and after tumor surgery.Results The tumor mass of cardiac myxoma showed an ascending trend as grading of NYHA increased in the patients(all P<0.05).The level of LVEF showed a descending trend,and LVEDd and PAH showed an ascending trend as grading of NYHA increased in the patients in all groups before the surgery(all P<0.05).The levelof LVEF increased and LVEDd and PAH decreased3m after the surgery in all groups(all P<0.05).The tumor mass of cardiac myxoma was negatively correlated to LVEF(r=-0.497,P<0.001)and positively correlated to LVEDD and PAH(r=0.553,r=0.572,all P<0.01)before the surgery.The pathological observation on tumor body showed that there were vascular and tumor cell invasion.Conclusion The tumor mass is closely related to heart function and PAH,and surgery can improve heart function and PAH in patients with left atrial myxoma.