超声心动显像评价心脏恶性肿瘤的手术、病理和尸检结果对照

目的：评价心脏恶性肿瘤的临床特点、手术所见、病理学类型、以及治疗情况；评价超声心动显像诊断心脏恶性肿瘤的准确性。方法：1983年至2002年12月在北京阜外心血管病医院手术和尸检及病理证实为心脏恶性肿瘤的患者27例。25例经手术和病理证实，2例尸检证实。24例为心脏原发恶性肿瘤，3例为转移性心脏恶性肿瘤。全部患者均有术前经胸超声心动显像检查资料。男17例，女10例。年龄1～72岁，平均34岁。结果：27例患者中，62．95％肿瘤位于右心(右心房占33．33％，右心室占14．81％，浸润房室环及同时波及右房室占14．81％。)；29．63％肿瘤位于左心(左心房占22．22％，左心室占7．41％)；7．41％位于心包。右心房肿瘤同时累及上腔静脉占14．81％，累及下腔静脉占14．81％，累及无名静脉占3．70％。左心房肿瘤同时累及肺静脉占7．41％。24例(88．89％)原发心脏恶性肿瘤中，间叶肉瘤11例(40．74％)，血管肉瘤5例(18．52％)，横纹肌肉瘤2例(7．41％)，纤维肉瘤2例(7．41％)，平滑肌肉瘤1例(3．70％)，非何杰金氏恶性淋巴瘤1例(3．70％)，心包间皮肉瘤2例(7．41％)。转移性心脏恶性肿瘤3例(11．11％)，其中转移性肝细胞癌2例占7．41％，转移性上皮肉瘤1例占3．70％。27例术前超声诊断均因缺乏经验，诊断心脏占位病变性质待定19例占70．37％，诊断粘液瘤可能性大8例占29．63％。结论：心脏恶性肿瘤多位于右心。不同类型的恶性肿瘤具有相似的超声所见，如肿块边界不规则、内部回声密度不均匀、多数较固定、肿块迅速增大等。一旦发现这些特点，应建议患者急诊或尽早手术。手术可清除肿瘤病灶，解除梗阻，延长患者的生命。

Echocardiographic Evaluating Cardiac Malignant Tumors:Comparison with Operation,Pathology and Autopsy Results

Objective:To evaluate clinical manifestations,surgical findi ngs,pathologic types and treatments of cardiac malignant tumor.and to analyze th eir echocardiographic characteristics.Methods:Records of 27 patients with cardiac malignant tumors confirmed by operations,pathology and autopsies at Fuwai Cardiovascular Hospital in Beijing,China between Jan,1983 and Dec,2002 were reviewed Clinical and ech ocardiographic data of all patients were abstracted Twenty five (25/27) patien ts were confirmed by operations and pathology;two (2/27) patients by autopsy T wenty four (24/27) patients were with primary cardiac malignant tumors,three (3/ 27) patients were with secondary cardiac tumors.Results:Median age of 27 patients was 34 yr (ranging:1~72 yr ) Male and female were 17 and 10 cases respectively The surgical findings rev ealed tha t 62 96% of malignant tumors were found in right heart,(33 33% in right atria, 14 81% in right ventricles,14 81% in atriaventricular annuli and right atria a nd ventricles),29 63% in left heart (22 22% in left atria,7 41% in left ventr icles),7 41% in pericardium The pathology revealed that 24 cases (88 89%) we r e diagnosed as primary malignant tumors including 11(40 74%) mesenchymal sarcom as,5 (18 52%) angiosarcomas,2 (7 41%) rhabdomyosarcomas,2 (7 41%) fibrosarcom as,1 (3 70%) leiomyosarcoma,1 (3 70%) non-Hodgkin's lymphosarcoma and 2 (7 4 1%)mesotheliosarcomas of pericardium Three cases (11 11%) were diagnosed as me tastatic cardiac malignant tumors by pathology,2 (7 41%) metastatic hepatocellu lar carcinomas,and 1 (3 70%) metastatic epithelioid sarcoma We were lack in ex perience using echocardiography for diagnosing cardiac malignant tumors before o peration:nineteen cases (19/27,70 37%) were diagnosed only as space occupying l esions of the heart,and eight cases (8/27,29 63%) were suspected as myxoma.Conclusions:Majority of malignant tumors of the heart occurred on right side and were sarcomas The different types of cardiac malignant tumo rs had similar echocardiographic findings such as irregular shape,heterogeneous acoustic density,fixation in majority,and rapid expansion According to these ch aracteristics,we suggest that emergency operation should immediately be done for the patients,because operation can excise the focuses,releive the obstructions, and prolong the patients lives.