单中心180例心脏肿瘤的诊断及外科治疗效果分析

Diagnosis and Surgical Treatment of Cardiac Tumors in 180 Patients in A Single Center

目的总结单中心10年心脏肿瘤的诊断及外科治疗策略,讨论心脏肿瘤临床治疗效果及预后。方法回顾性分析2013年01月至2022年12月于高州市人民医院心血管外科住院诊断为心脏肿瘤并外科手术治疗的患者资料。收集整理患者的围术期临床资料及随访情况,分析其诊断及外科治疗策略。结果全组180例,其中男76例,女104例,年龄为(55.96±16.01)岁;良性肿瘤为165例(91.67%),恶性肿瘤为15例(8.33%)。术中完整切除肿瘤169例(93.89%),次全切除11例(6.11%)。术中同期合并冠状动脉旁路移植术10例(5.5%),主动脉瓣置换1例(0.55%),二尖瓣成形2例(1.11%),三尖瓣成形术3例(1.67%)。体外循环时间为(105.22±11.24)min,主动脉阻断时间为(43.17±24.61)min,机械通气时间为(14.21±3.18)h,术后重症监护病房(ICU)停留时间为(2.46±1.21)d,胸液总量为(317.25±43.15)mL。全组围术期无死亡,随访时间为45.28(1~120)个月,黏液瘤复发3例(1.9%),恶性肿瘤复发3例(20%),死亡17例(9.4%)。结论心脏肿瘤缺乏特征性临床表现,需要综合影像学检查明确诊断。原发性良性心脏肿瘤的手术效果满意,安全可行;并且可采用更加微创化的治疗方式。恶性心脏肿瘤的预后差,建议及早治疗及个体化治疗。

Objectives To summarize the diagnosis and surgical treatment of cardiac tumors for 10 years in a single center,and discuss the clinical outcomes and prognosis.Methods We retrospectively analyzed the data of patients in Gaozhou People's Hospital from January 2013 to December 2022 who were diagnosed with cardiac tumor and underwent surgical treatment.The perioperative clinical data and follow-up were collected,and the diagnosis and surgical treatment strategies were analyzed.Results There were 180 patients in the group,including 76 males and 104 females,aged(55.96±16.01)years.There were 165 patients(91.67%)with benign tumors and 15 patients(8.33%)with malignant tumors.Total resection was performed in 169 patients(93.89%)and subtotal resection was performed in 11 patients(6.11%).Ten patients(5.5%)underwent coronary bypass grafting,1 patient(0.55%)underwent aortic valve replace‐ment,2 patients(1.11%)underwent mitral valvuloplasty,and 3 patients(1.67%)underwent tricuspid valvuloplasty.Cardiopulmonary bypass duration was(105.22±11.24)min,clamp duration was(43.17±24.61)min,mechanical venti‐lation duration was(14.21±3.18)h,intensive care unite(ICU)stay duration was(2.46±1.21)d,and total amount of thoracic fluid was(317.25±43.15)mL.There were no deaths in the perioperative period of the whole group.The average follow-up duration was 45.28(1-120)months.There were 3 patients of myxoma recurrence(1.9%),3 patients of malig‐nant tumor recurrence(20%),and 17 patients of death(9.4%).Conclusions Cardiac tumors lack characteristic clinical manifestations and need comprehensive imaging examination for definite diagnosis.The operative effect of primary benign cardiac tumors is satisfactory,safe and feasible.And more minimally invasive treatments are available.The prognosis of malignant cardiac tumors is poor.Early treatment and individualized treatment are recommended.