心脏恶性肿瘤的诊断与外科治疗

目的探讨心脏恶性肿瘤的特点,总结其诊断和外科治疗经验。方法回顾性分析2005年1月至2012年2月期间哈尔滨医科大学附属第二医院心脏外科收治的16例心脏恶性肿瘤患者的临床资料。其中男8例、女8例,年龄35~64（47.8±10.9）岁,病程15 d~48个月（11.8±10.9）个月。16例患者中有13例在体外循环下行肿瘤切除术,其中除有1例将肿瘤及其蒂附着的周围组织完全切除外,其余12例仅行肿瘤大部切除,同期行三尖瓣置换术1例。结果全部患者均手术顺利,除1例术后第6 d死于低心排血量综合征和多器官功能衰竭外,其余患者术后均恢复顺利出院。所有手术患者平均手术时间（181.2±59.5）min,平均体外循环时间（68.8±20.8）min,平均总住院时间（20.4±7.4）d。术后病理诊断结果：原发性心脏恶性肿瘤9例,转移性恶性肿瘤6例,良性肿瘤恶性生长1例。在术后随访中,3例患者术后时间尚短（≥3个月）,现生存良好;9例陆续于术后1~14个月死亡;1例良性肿瘤恶性生长患者生存状态良好。结论心脏恶性肿瘤临床少见,恶性程度高,误诊率高,手术效果尚满意,但预后较差。

Diagnosis and Surgical Treatment of Malignant Cardiac Tumors

Objective To investigate clinical characteristics of patients summarize our diagnostic methods and surgical treatment experience. Methods with malignant cardiac tumors, and Clinical data of 16 patients with mali- gnant cardiac tumors who were admitted to Department of Cardiovascular Surgery, Second Affiliated Hospital of Harbin Medical University between January 2005 and February 2012 were retrospectively analyzed. There were 8 male and 8 female patients with their age of 35-64 （47.8±10.9） years and disease duration of 15 days to 48 months （ 11.8± 10.9） months. Among the 16 patients, 13 patients underwent tumor resection under cardiopulmonary bypass （CPB）, including 1 patient who received complete resection of the tumor and pedicle surrounding tissue and other 12 patients who only received partial tumor resection. One patient underwent concomitant tricuspid valve replacement. Results All the operations were performed successfully. One patient died of low cardiac output syndrome and multiple organ dysfunction syndrome on the 6th postoperative day. All the other patients were successfully discharged. Average operation time was 181.2± 59.5 minutes, average CPB time was 68.8±20.8 minutes, and average length of hospital stay was 20.4 ± 7.4 days. Postoperative pathological examination showed primary cardiac malignant tumors in 9 patients, metastatic malignant tumors in 6 patients, and benign tumor with malignant growth in 1 patient. Three patients were followed up for a short time （ ≥ 3 months ） and were still alive. Nine patients died in 1-14 months after discharge. One patient with benign cardiac tumor but malignant growth was still alive. Conclusion Malignant cardiac tumors are rare but highly malignant with a high rate of misdiagnosis. Surgical outcomes are comparatively satisfactory, but these patients＇ prognosis is usually poor.