原发性心脏肿瘤外科治疗效果及预后的影响因素分析

目的  分析原发性心脏肿瘤患者临床资料，对可能影响治疗效果及患者预后的相关因素进行分析，为提高心脏肿瘤外科治疗效果，改善预后提供依据。方法  回顾性分析1990年1月-2014年9月于西安交通大学第一附属医院接受手术治疗的140例原发性心脏肿瘤患者的临床资料，包括一般情况、家族史、心脏功能、以及肿瘤大小、生长分布、病理类型等，并将上述资料与患者手术效果、预后及转归进行相关性分析。结果  肿瘤的病理类型、瘤体大小、术前心功能对手术疗效有显著影响，罹患良性黏液瘤、肿瘤体积<100 cm3、术前心功能较好的患者更易获得治愈，而罹患恶性肿瘤、肿瘤体积≥300 cm3、术前心功能较差的患者围手术期死亡率较高；对预后的影响方面，年龄较小、既往无心血管病史、罹患良性黏液瘤、术前及术后心功能较好的患者术后生存期较年长、罹患恶性肿瘤、心功能较差的患者术后生存期明显延长；相关性分析结果显示，病理类型、瘤体大小、术前心功能与临床疗效呈正相关，既往心血管病史和术后心功能分级与患者术后生存时间呈负相关。结论  良性肿瘤、较小的肿瘤体积以及较好的术前心功能可明显提高手术治愈率，减少死亡率；而术后心功能良好、无既往心血管病史的患者生存期较长。

Factors affecting surgical effects and prognosis of primary cardiac tumors

Objective To investigate the factors affecting surgical effects and prognosis of patients with primary cardiac tumors so as to provide the effective guidance for cardiac tumor surgery. Methods The cases who received cardiac tumor surgeries in our hospital from January 1990 to September 2014 were analyzed. The clinical data including family history, heart function, tumor size, tumor distribution, pathological type, etc. were investigated; their correlations with effect and prognosis of cardiac tumor surgery were also explored. Results The pathological type, tumor size (range of lesion) and preoperative cardiac function had significant effects on surgical curative effect. The patients with benign myxoma, tumor size <100 cm3 or good cardiac function obtained a better outcome than those with malignant tumor, tumor size ≥300 cm3 or poor heart function. The patients who were younger, suffered from benign myxoma, had better cardiac function, or did not have preoperative cardiovascular disease had a significantly longer survival time than those who were older, suffered from malignant tumor, or had poor heart function. Correlation analysis showed that pathological type, tumor size and preoperative cardiac function had positive correlations with the clinical effect; while cardiovascular disease history and postoperative cardiac function had negative correlations with postoperative survival time. Conclusions The risk factors of surgical effect for patients with primary cardiac tumors involve malignant tumor, a large tumor size and poor preoperative heart function; the protective factors of  prognosis are absence of cardiovascular disease history and good postoperative cardiac function.