心脏肿瘤外科治疗45例临床分析及右胸切口手术经验总结

目的：探讨心脏肿瘤临床特点, 总结外科治疗经验。方法：回顾分析2008年1月至2017年6月我科45例心脏肿瘤手术患者（3例为复发患者）的临床资料，比较右胸前外侧切口与胸骨正中切口手术的疗效。结果：本组病例中男性19例（42.2%），年龄52±18岁，术前9例（20%）合并心功能不全。左房占位33例，右房占位9例，左室、右室和多发占位各1例。胸骨正中切口34例，右胸前外侧切口微创手术11例。全组无围术期死亡，右侧微创切口与正中切口组相比，手术时间、术后恢复和术后并发症发生率均无显著差异。全组良性肿瘤42例（93.3%），其中粘液瘤33例；恶性肿瘤3例（6.7%）。随访无死亡、无复发。结论：心脏肿瘤良性疾病多见，手术效果优良，完整切除是预防复发的重要因素。经右胸微创切口切除心脏肿瘤技术可行，疗效确切，可作为常规胸骨正中切口手术方法的补充。

Clinical Analysis of Forty-Five Surgeries of Cardiac Tumor and Experience of Operation with Right Thoracotomy

Objective: To summarize the clinical features and surgical experiences of cardiac tumor. Methods: Forty-five surgical patients of cardiac tumor (including 3 relapsed patients) from Jan 2008 to Jun 2017 were retrospectively reviewed. The surgical results between sternotomy and right thoracotomy were compared. Results: There were 19 males (42.4%), and the mean age were 52±18 years. Nine patients (20%) had pre-operative heart failure. The tumors were found in left atrium in 33 patients, while they were found in right atrium in 9 patients. In the other 3 patients, tumors were also found in left ventricle, right ventricle and multiple cardiac chambers. Thirty-four patients underwent sternotomy and 11 patients had right thoracotomy. There was no peri-operative death. No difference was found in surgical time, post-operative recovery and post-operative complications between sternotomy and thoracotomy groups. The pathological examinations revealed 42 benign (33 myxomas) and 3 malignant tumors. No death and no recurrence were seen during the follow-up. Conclusions: Benign tumors is more frequently seen in cardiac mass. Surgical treatment results in good prognosis, and complete resection is the key to prevent relapse. Surgery from right thoracotomy is feasible and effective in treatment of cardiac tumor, and it is an alternative therapy additional to surgery from sternotomy.