23例心脏肿瘤的临床特点与外科诊治分析

【目的】探讨23例心脏肿瘤临床特点，总结外科诊断和治疗的经验。【方法]2002年6月至2009年12月手术治疗23例心脏肿瘤患者，其中心脏粘液瘤13倒，原发性心脏恶性肿瘤4例，右心下腔静脉平滑肌瘤5例，肝癌右心房转移性癌栓1例。所有病例术前均查心脏彩超，怀疑恶性者行CT或核磁共振检查，除1例患者因右房肿瘤广泛侵犯右房室环及心包而仅做活检外，其余22例均在全麻低温体外循环辅助下行肿瘤切除术。【结果】住院期间全组病例无死亡，13例粘液瘤患者平均随访2年无复发转移。5例心脏恶性肿瘤患者中除1例因患者无法联系外，余4例均在2年内死亡。右心下腔静脉平滑肌瘤患者中有1例于术后一年半经MRI证实复发。【结论】原发性心脏良性肿瘤以黏液瘤多见，彻底切除肿瘤是防止复发的关键。心脏恶性肿瘤预后差，早期手术治疗并辅以综合治疗可望改善预后。

Surgical Treatment of Cardiac Tumors

Objective] To explore the clinical characteristics, diagnosis and surgical treatments of 23 cardiac tumors. Methods] Twenty three patients were operated from June 2002 to December 2009, including 13 cases of myxomas, 4 cases of primary malignant tumors, 5 cases of intraeardiae leiomyomatosis and 1 case of hepatocellular carcinoma with tumor thrombus in the right atrium. All patients received ECG examinations. Patients suspected of malignant tumors were examined by CT or MRI Except only one underwent open chest biopsy for the tumor with the invading of right atrioventricular ring and pericardium, the other 22 patients received tumor resection under hypothermic eardiopulmonary bypass （CPB）. Results] No patient died before discharge. There were no recurrences in 13 myxomas during within 2-year follow up. Among 5 cases of cardiac tumor, 4 cases of malignant neoplasm died in two years after surgery except one people was unable to contract. MRI confirmed that I case of intraeardiae leiomyomatosis recurred one and a half year after the operation. Conclusion] Most of primary heart tumor are myxomas. Radical resection is the key to prevent recurrence. The prognosis of cardiac malignant tumor is poor. Early operation combined comprehensive therapy may improve the prognosis.