不停跳冠状动脉旁路移植术联合同期肺切除术

目的总结不停跳冠状动脉旁路移植术联合同期肺切除术的经验。方法7例不稳定性心绞痛或心肌梗死合并可切除肺部病变患者,实施不停跳冠状动脉旁路移植术联合同期肺切除术。所有患者术前行冠状动脉造影证实不宜行冠状动脉成形术或支架植入术。采用胸骨正中切口,不停跳冠状动脉旁路移植术后行肺切除术。左上肺叶切除2例,右上肺叶切除1例,右上、中叶切除1例,右下肺叶切除1例,左侧肺减容术1例,双侧肺减容术1例。结果本组无住院死亡,但有1例后期死亡。术后并发症包括1例胸骨哆开再次开胸固定、1例房颤。病理检查结果5例肺部恶性肿瘤、2例慢性阻塞性肺气肿。患者随访2～31个月,所有患者术后没有再次出现心肌缺血症状,1例行右肺上、中叶切除患者术后19个月出现局部复发。结论胸骨正中切口不停跳冠状动脉旁路移植术联合同期肺切除术是安全有效的并能降低术后并发症。     

同期施行瓣膜和冠状动脉手术的危险因素

目的探讨行冠状动脉旁路手术同时行心脏瓣膜手术的危险因素。方法回顾性分析2000年12月至2005年1月间126例行体外循环下冠状动脉旁路移植术（CABG）同期行瓣膜手术患者的临床资料。按照性别分为男性组和女性组,男84例,女42例。采用胸骨正中切口,2组都在中度低温体外循环心脏停跳下完成搭桥和瓣膜手术。结果2组患者术前体重、糖尿病及风湿性二尖瓣狭窄、冠状动脉三支血管病变等差异都有统计学意义（P〈0．05）,患者术后病死率和并发症的发生率差异有统计学意义,二尖瓣置换手术女性明显多于男性（P〈0．05）,男性组术后死亡5例,其中心脏衰竭1例,应激性高血糖昏迷1例,严重心律失常2例,心。肾肺多脏器衰竭1例;女性组术后死亡7例,其中心脏衰竭1例,应激性溃疡消化道大出血1例,严重心律失常3例,心肾肺多脏器衰竭2例。结论CABG同期行瓣膜手术是安全有效的,女性的并发症发生率和病死率高于男性,这与女性的低体重及风湿性二尖瓣狭窄病变等构成独立的危险因素有关。     

合并肺气肿的肺或食管肿瘤切除术中同期行肺减容术

目的评价在肺或食管肿瘤手术中同期行肺减容术（LVRS）的可行性和效果。方法45例肺肿瘤和37例食管肿瘤病人，随机分为甲组和乙组，甲组在肿瘤切除手术中同期行开胸侧LVRS，根据术前胸部CT、灌注通气肺扫描结果，确定肺无功能区，切除一侧肺叶的20％～30％；乙组为单纯肿瘤切除术组。随访6～12个月，对比手术前、后肺功能、血气、呼吸困难指数、6min行走距离（6MWD）等指标。结果两组均无围术期死亡，术后FEW1、PaO2、PaCO2、呼吸困难指数以及6MWD甲组病人较术前改善，乙组较术前变化不明显或有轻度下降。结论对合并肺气肿的肿瘤病人，同期LVRS不仅增加了病人的手术机会，而且提高了病人术后生活质量。LVRS扩大了肿瘤病人的手术适应证。     

同期肺叶切除联合心脏手术的临床应用

目的总结同期肺叶切除联合心脏手术治疗肺部疾病合并心脏病患者的临床经验。方法回顾性分析2003年2月至2009年9月同济大学附属东方医院8例肺部疾病合并心脏病患者同期行肺叶切除联合心脏手术治疗的临床资料,其中男4例,女4例;年龄(65±3)岁。行左肺上叶切除术1例、左肺下叶切除术2例,右肺上叶切除术2例、右肺上、中叶切除术1例、右肺下叶切除术2例;主动脉瓣置换术2例,左心房部分切除术1例,冠状动脉旁路移植术5例。结果无围术期死亡,术后发生心房颤动1例,经药物治疗复律成功;发生一过性神经系统功能障碍1例。术后病理诊断:鳞癌4例,腺癌2例,错构瘤1例,肉芽肿1例。随访8例,随访时间6～48个月。随访期间未发现局部或远处转移征象,未出现心绞痛复发、心肌梗死、血栓和心律失常,心功能分级(NYHA)Ⅰ～Ⅱ级。结论在选择患者的条件下,同期施行肺叶切除联合心脏手术治疗肺部疾病合并心脏病患者,是一种安全、有效的治疗方法。     

原发性心脏肿瘤的外科治疗

目的总结原发性心脏肿瘤的外科治疗经验,以提高手术疗效。方法回顾性分析1980年6月至2008年12月中国医科大学附属第一医院收治的263例原发性心脏肿瘤患者的临床资料,其中男90例,女173例;年龄10~79岁（41±13岁）。良性肿瘤241例,其中良性粘液瘤240例,纤维瘤1例;恶性肿瘤22例,其中恶性粘液瘤7例,恶性间皮瘤4例,血管肉瘤5例,横纹肌肉瘤1例,肺动脉内膜肉瘤1例,平滑肌肉瘤1例,炎症性恶性纤维组织细胞瘤1例,恶性淋巴瘤1例,滑膜肉瘤1例。手术完整摘除肿瘤252例（恶性肿瘤11例）,局部切除肿瘤5例（均为恶性肿瘤）,开胸探查取病理活组织检查6例（均为恶性肿瘤）。同期行冠状动脉旁路移植术（CABG）5例,二尖瓣置换术5例,二尖瓣成形术4例,三尖瓣成形术9例,三尖瓣生物瓣置换术1例,主动脉根部及肺动脉成形术1例,肺动脉瓣置换术1例,肺动脉主干及左右肺动脉人工血管加肺动脉瓣置换术1例,肺动脉切开取栓术1例,经股动脉取瘤栓术5例。结果围术期死亡7例（良性粘液瘤6例、恶性粘液瘤1例）,其中术中不能停体外循环2例,术后发生低心排血量、心室颤动3例,呼吸、循环衰竭1例,大面积脑出血1例;其余患者无并发症发生。随访247例（良性肿瘤229例,恶性肿瘤18例）,随访时间3个月~28年,失访9例（良性肿瘤6例、恶性肿瘤3例）。随访期间良性粘液瘤复发4例,均再次手术治疗;良性肿瘤患者死亡13例（心源性猝死6例、脑卒中2例、肺癌1例、不明原因4例）,其余216例均生存。随访期间恶性肿瘤患者死亡15例,术后生存时间为1~4年,死于肿瘤复发或转移11例,心力衰竭和恶病质各2例。结论原发性心脏肿瘤一经确诊应尽早手术治疗,良性肿瘤手术效果好,恶性肿瘤术中应尽量切除肿瘤。     

非缺血性心脏瓣膜疾病合并冠心病同期手术治疗的临床分析

目的 总结非缺血性心脏瓣膜疾病合并冠心病同期手术患者的临床特征和手术效果,以提高手术疗效. 方法 2000年1月至2007年6月同期手术治疗105例非缺血性心脏瓣膜疾病合并冠心病患者,年龄36～79岁(61.96±7.61岁),其中风湿性心瓣膜疾病59例,退行性二尖瓣病变24例,老年性钙化性主动脉瓣病变13例;其它主动脉瓣病变9例.术前行冠状动脉造影明确诊断98例,术中探查发现冠心病7例.全组均行冠状动脉旁路移植术,共移植血管216支(2.06支/例),同期行二尖瓣置换术36例,二尖瓣成形术15例,主动脉瓣置换术43例,双瓣膜置换术11例. 结果 术后住院死亡6例(5.7%,6/105).死于严重低心排血量3例,肾功能衰竭2例,术后心脏骤停并发多器官功能衰竭1例.术后随访93例,随访时间1个月至7年,失访6例.无晚期死亡患者.心功能分级(NYHA)Ⅰ级25例,Ⅱ级53例,Ⅲ级10例,Ⅳ级5例.1例患者活动后仍有心绞痛存在. 结论 非缺血性心脏瓣膜疾病合并冠心病患者绝大多数无典型的心绞痛症状,50岁以上的患者必须行冠状动脉造影检查,对有冠心病易患因素者,应积极作冠状动脉造影检查;冠心病所致的心肌缺血可明显加重心脏瓣膜疾病所引起的心肌损害,术中心肌保护尤为重要;正确评价术前左心功能低下的患者是选择手术治疗的难点,更是影响手术效果的关键因素.     

单中心连续500例全胸腔镜肺叶切除治疗非小细胞肺癌

目的 总结单中心连续500例非小细胞肺癌接受全胸腔镜肺叶切除病例资料和中期随访结果,探讨全胸腔镜肺叶切除治疗非小细胞肺癌的安全性、有效性和彻底性.方法 2006年9月至2011年9月,500例接受全胸腔镜肺叶切除的非小细胞肺癌患者中男267例,女233例;平均年龄62.3岁.肿瘤最大径2.65 cm.初治病例496例,肿瘤放化疗后手术4例.肿瘤位于左肺上叶129例、下叶73例,右肺上叶163例、中叶47例、下叶89例(其中1例左肺下叶和右肺中叶同时性双原发癌).手术方式为全胸腔镜下解剖性肺叶切除+系统性淋巴结清扫(包括至少3组纵隔区域淋巴结),其中单纯肺叶切除480例,复合肺叶切除(肺叶+肺叶或肺叶+肺段切除)13例,解剖性肺段切除3例,全肺切除2例,全胸腔镜下支气管袖式切除1例,同期双侧肺叶切除1例.结果 全组手术顺利,围手术期死亡1例,为高龄肺癌患者术后多器官功能衰竭死亡.手术平均198.1 min,术中出血平均214.6 ml,无严重并发症.术后肺动脉残端渗血5例,4例经再次胸腔镜手术止血,1例经保守治疗好转.术中每例平均清扫淋巴结5.7组,16.9个.中转开胸45例,中转开胸率9.0％.术后带胸管7.8天,术后平均住院10.2天.轻微并发症87例,主要包括持续心律失常等心脏异常32例,漏气超过7天28例,肺部感染或肺不张9例,乳糜胸6例,其他并发症12例.术后病理示腺癌363例,鳞癌85例,腺鳞癌12例,肺泡细胞癌28例,大细胞癌6例,其他6例.术后病理分期示Ⅰ a期161例,Ⅰb期176例,Ⅱa期46例,Ⅱb期14例,Ⅲa期85例,Ⅲb期3例,Ⅳ期15例.全组1年无瘤生存率(DFS)为90.2％,1年总体生存率(OS)为94.3％;3年分别为76.4％和81.3％.结论 全胸腔镜肺叶切除治疗早期非小细胞肺癌是一种安全、有效的手术方式,其彻底性与开胸术相仿.     

冠状动脉旁路移植术同期经旁路血管移植自体干细胞治疗缺血性心衰

目的 评价冠状动脉旁路移植手术同期经旁路血管移植自体骨髓干细胞治疗缺血性心衰的可行性和安全性.方法 40例需外科手术治疗的陈旧性心梗伴左室功能不全病人,在冠状动脉旁路移植手术同期经旁路血管移植自体骨髓单个核细胞.结果 全组手术死亡1例.手术早期无心梗发生,无肝、肾功能衰竭,无新发恶性心律失常.结论 冠状动脉旁路移植术同期经旁路血管移植自体骨髓单个核细胞治疗冠心病陈旧心梗,为缺血性心衰病人提供了一个全新的综合治疗选择.     

101例心脏粘液瘤的外科治疗体会

目的总结101例心脏粘液瘤的诊断和治疗经验,以提高疗效。方法回顾性分析101例心脏粘液瘤患者的临床资料,其中左心房粘液瘤94例,右心房粘液瘤6例,双心房粘液瘤1例,均在体外循环下行粘液瘤摘除术;同期行二尖瓣成形术5例,二尖瓣机械瓣置换术1例,三尖瓣成形术32例,冠状动脉旁路移植术1例,激光心肌打孔血运重建术1例。结果术后死亡1例,100例患者经治疗痊愈出院。随访84例,随访率84%(84/100);随访时间3个月~5年,复发1例。结论心脏粘液瘤术前超声心动图检查诊断准确率高,一经确诊应尽早手术;手术的关键是保持瘤体完整,将瘤体连同蒂部周围部分组织一并切除。     

冠状动脉旁路移植术治疗6例儿童川崎病并发冠状动脉病变

目的 总结冠状动脉旁路移植治疗儿童川崎病并发冠状动脉病变的近、中期疗效.方法 2005年2月至2009年9月,6例川崎病并发冠状动脉病变病儿接受冠状动脉旁路移植,其中男5例,女1例;年龄6～12岁.确诊川崎病0.5～5.0年.冠状动脉左主干闭塞1例,左、右冠状动脉瘤样病变5例.心功能(NYHA)分级Ⅱ级1例,Ⅲ级5例.术前心脏超声示左室舒张末内径(LVDD)39～54 mm;左室收缩未内径(LVSD)23～45 mm;左室射血分数(LVEF)0.33～0.71;二尖瓣中度反流1例.均在体外循环下手术,移植血管均用动脉,平均旁路移植血管(2.0±0.6)根.其中左乳内动脉4根,桡动脉7根.同期冠状动脉成形术4例,二尖瓣成形术1例.结果 无手术死亡,体外循环平均(95.6±31.0)min;主动脉阻断平均(57.8±33.9)min.术后LVDD 32～56 mm,LVSD 21～39 mm,LVEF 0.45～0.71.冠状动脉CT示移植血管均通畅.均获随访,无远期死亡,病儿生长发育同正常同龄儿.随访0.1～4.5年,心功能平均(1.4±0.55)级.5例术后1年移植血管100%通畅,1例术后2年移植血管通畅.结论 冠状动脉旁路移植术可以有效治疗川崎病并发冠状动脉病变,全动脉化有利于旁路血管远期通畅,其近、中期疗效满意.     

Simultaneous cardiac surgery with pulmonary resection: presentation of series and review of literature

Background: The issue of performing simultaneous pulmonary resection and cardiac surgery in patients with coexisting lung carcinoma and ischaemic heart disease remains controversial. We report our experience and review the literature. Methods: Thirteen patients (male ten, female three; mean age 65 years) underwent simultaneous cardiac surgery and pulmonary resection. Lung pathology consisted of primary lung carcinoma (n=10), benign disease (n=2) and carcinoid (n=1). Lung resections included pneumonectomy (n=3), lobectomy (n=4), segmentectomy (n=1) and local excision (n=5). Cardiac procedures consisted of coronary artery bypass grafting (CABG) in 11, aortic valve replacement in one and mitral valve repair with CABG in one patient. In all but one case the lung resection was performed prior to heparinization and cardiopulmonary bypass (CPB). In two patients, with suitable coronary anatomy, myocardial revascularization without CPB was performed to reduce morbidity. Results: There was no hospital mortality. Postoperative blood loss and ventilation requirements were reduced in the patients who were operated on without CPB. Prolonged ventilatory support was required in two cases. All patients with benign pathology are alive. In the lung cancer group there have been five late deaths: disseminated metastatic disease (n=3), anticoagulant related haemorrhage (n=1) and broncho-pleural fistula (n=1). Of the remaining five patients four are alive and disease free 7–23 months post-operatively; one patient has recurrent disease 40 months post-operatively. Conclusions: Simultaneous pulmonary resection and cardiac surgery is associated with acceptable operative morbidity and mortality. In patients with lung carcinoma long-term survival was determined by tumour stage. The avoidance of CPB may be advantageous by decreasing blood loss and ventilation requirements.     

Simultaneous cardiac operations with pulmonary resection for lung carcinoma

OBJECTIVES: A procedure remains to be established for managing patients with both cardiac and pulmonary diseases requiring surgical interventions. We review our experience with 6 patients having cardiac disease and lung cancer surgically treated simultaneously to determine whether simultaneous surgery is safe and effective. METHODS: Subjects were 6 men with a mean age of 64 +/- 10 years undergoing cardiac surgery combined with pulmonary lobectomy from January 1986 through June 2000. Cardiac procedures consisted of coronary artery bypass in 3, coronary artery bypass plus left ventricular aneurysm repair, aortic valve replacement, and minimally invasive direct coronary artery bypass surgery in 1 patient each. All underwent lobectomy. RESULTS: No early deaths occurred. Bleeding complications occurred in 2 patients and lymph node dissection was incomplete in 3. Two died of carcinoma-related events, 1 at 28 and the other at 84 months after surgery. One died suddenly from a cardiac-related event 42 months after surgery. Only 1 patient is currently alive and disease-free at 104 months after surgery. CONCLUSION: Simultaneous surgery can be conducted with acceptable mortality. The occurrence of bleeding complications and incomplete lymph node dissection, however, indicates combined procedures only in patients requiring simultaneous surgery due to their disease or unable to tolerate a second operation.     

冠状动脉旁路移植术同期行心脏瓣膜置换手术59例临床分析

目的 研究冠状动脉旁路移植同时行心脏瓣膜置换手术治疗非缺血性心脏瓣膜疾病合并冠心病的疗效.方法 59例冠状动脉旁路移植同时行瓣膜置换手术,包括二尖瓣瓣膜病变40例及主动脉瓣瓣膜病变11例,联合瓣膜病变8例,共搭桥132支.根据患者年龄及病变血管情况选用乳内动脉或大隐静脉作为血管桥.结果 本组1例术后1d死亡,死亡原因是严重的低心排综合征,搭桥4根.其他病例术后随访2个月至7年,均没有明显心绞痛复发并且心功能得到改善.结论 非缺血性心脏瓣膜疾病合并冠心病患者一般无典型心绞痛病史,有冠心病高危因素的患者术前应该常规行冠状动脉造影检查明确是否合并冠心病.采取术前改善心功能状态,缩短手术及心肌缺血时间等措施,同时行冠状动脉旁路移植手术及心脏瓣膜手术是有效可行的治疗手段.     

Thoracic and cardiovascular interventions after orthotopic heart transplantation.

BACKGROUND: The long-term outcome of orthotopic heart transplantation is limited by the development of cardiac allograft vasculopathy, rejection, infection, and malignancy. METHODS: After heart transplantation, we treated patients with thoracic and cardiovascular diseases: preexisting coronary artery sclerosis in 2 patients, cardiac allograft vasculopathy in 19, valvular disease in 3, mycotic ascending aortic aneurysm in 2, superior vena cava stenosis in 2, and lung neoplasm in 10 patients. RESULTS: We successfully performed coronary artery bypass grafting for preexisting coronary artery sclerosis, valve replacement for valvular disease, and patch enlargement for superior vena cava stenosis. Percutaneous transluminal coronary angioplasty for cardiac allograft vasculopathy achieved excellent initial results, but the incidence of restenosis was high (67%). One patient who underwent coronary artery bypass grafting for cardiac allograft vasculopathy died immediately after operation. Graft replacement was performed for mycotic aortic aneurysm, but 1 patient required reoperation because of recurrent aneurysm. The long-term survival rate in patients undergoing surgical resection for lung neoplasm was poor (50%). CONCLUSIONS: The need for thoracic and cardiovascular interventions in patients after heart transplantation was low (4.7%). Use of the appropriate procedures can improve the long-term survival after heart transplantation.     

Coronary artery bypass grafting after orthotopic heart transplantation.

OBJECTIVE: Graft coronary disease (GCD) remains the major determinant of long-term survival after heart transplantation. Therapeutic strategies for the prevention or retardation of GCD in the cardiac allograft are limited, and palliative surgical coronary revascularization has been attempted. The aim of this report was to retrospectively analyze our results of coronary artery bypass grafting after cardiac transplantation. This paper correlates the outcome of patients with the pathohistological and angiographic type of lesion in order to identify transplant recipients who may profit from surgical myocardial revascularization. METHODS: Seven patients with a mean age of 55 years (range 45-61 years) underwent coronary artery bypass grafting as a result of GCD at a mean of 67 months (range 6-128 months) after cardiac transplantation. By the inclusion of the clinical history and the angiographic pattern of GCD lesions, the primary indications for surgical revascularization, operative results, pathohistological studies and follow-ups were examined. RESULTS: Elective surgery was performed in two patients with proximal, severe triple vessel disease (Type A lesion) and in one patient in whom the primary reason for cardiac surgery was severe tricuspid regurgitation. This patient electively received a tricuspid valve replacement and concomitant single vessel bypass surgery for proximal GCD (Type A lesion). Emergency surgery was performed in four patients: preoperatively three patients post-infarction developed worsening congestive heart failure, which resulted in low cardiac output syndrome. One patient with combined Types A and B/C lesions required emergency surgery for dissection of the right coronary artery (RCA) after an angioplasty procedure. Angiographically all these patients showed diffuse, distal arteriopathy (combined Type B/C lesions). The electively operated patients (n = 3) and the patient with dissection of the RCA (n = 1) had successful operations and survived beyond hospital discharge (overall survival for coronary artery bypass graft (CABG) in GCD patients 4 out of 7; 57%). All three patients with distal arteriopathy, who underwent emergency surgery, died in hospital from left ventricular failure (43%). The four patients discharged from hospital with a mean follow-up of 10 months (range 2-32 months) are all in good clinical condition. CONCLUSIONS: Coronary artery bypass grafting can be successfully performed in a subgroup of cardiac transplant patients with Type A lesions. However, the state of diffusely diseased distal arteries (Type B/C lesions), which is prevalent in this group of patients, limits the use of bypass surgery.     

Use of a retractor designed to harvest an internal thoracic artery graft during cardiac surgery for patients with a unilateral lung.

Adequate exposure of the heart is required for safe cardiac surgery. We performed open heart surgery for 2 patients with a unilateral lung. In one patient, coronary artery bypass grafting was performed 13 years after left pneumonectomy for lung cancer. Mitral valve replacement was performed in the other patient whose left lung was entirely collapsed due to tuberculosis. The heart was markedly deviated to the left in both patients. A retractor designed to harvest the internal thoracic artery was very useful to obtain a good operative view of the heart. The operations were uncomplicated, and postoperative recovery was uneventful in both patients.     

Concomitant lobectomy for lung cancer under intraaortic balloon pumping and coronary bypass grafting

A 71-year-old man was admitted because of an abnormal shadow on the chest X-ray film. Chest computed tomography (CT) revealed a tumor in the right upper lobe. The diagnosis of lung cancer was made by transbronchial lung biopsy. He had suffered an infarction of the inferior myocardial wall at the age of 55 years. Preoperative coronary angiography revealed total occlusion of segment 1, 75% stenosis of segments 5 and 6, and 90% stenosis of segment 13. Since these coronary lesions could cause perioperative and postoperative myocardial infarction, the patient was scheduled to undergo surgery of both the heart and lung in a one-stage operation. Under intraaortic balloon pumping (IABP), we performed a right upper lobectomy of the lung, and coronary artery bypass grafting with cardiopulmonary bypass through median sternotomy. During the lobectomy and first postoperative day, a stable circulation was achieved with IABP. The postoperative course was uneventful. At present, that is 33 months after the operation, the patient presents no sighs of recurrence of lung cancer and has not suffered any anginal attack during follow-up. Lung cancer and coronary artery disease can be treated simultaneously by this procedure.     

1113例心脏瓣膜置换手术后急性肾损伤的临床分析

目的 研究不同类型心脏瓣膜置换手术后急性肾损伤（AKI）的发病情况及其危险因素。 方法 采用前瞻性队列研究。收集本院心外科2009年4月1日至2010年3月31日期间进行心脏瓣膜置换手术患者的临床资料,采用多因素回归方法筛选出各类心脏瓣膜置换患者术后发生AKI的危险因素。AKI诊断标准为48 h内Scr上升≥26.4 μmol/L或较基础值增加≥50%;和（或）尿量<0.5 ml?kg-1?h-1达6 h。结果 1113例瓣膜置换手术患者术后AKI发病率为33.24%,AKI患者住院病死率为6.49%,其死亡风险较非AKI患者增加5.373倍 （P < 0.01）。心脏瓣膜置换伴冠脉搭桥手术术后AKI发病率为75.00%,显著高于其它瓣膜置换手术类型（P < 0.01）。多因素非条件Logistic回归分析表明,年龄（每增加10岁）、男性、术中体外循环时间≥120 min以及心脏瓣膜置换合并冠脉搭桥手术是术后发生AKI的独立危险因素,OR值分别为1.455、2.110、1.768和2.994。 结论 AKI是心脏瓣膜置换手术后常见的严重并发症。心脏瓣膜置换合并冠脉搭桥手术术后更容易发生AKI。高龄、男性、术中体外循环时间≥120 min以及心脏瓣膜置换合并冠脉搭桥手术是心脏瓣膜置换术后发生AKI的独立危险因素。     

小儿原发性心脏肿瘤27例分析

目的 探讨原发性心脏肿瘤的治疗经验.方法 回顾性分析1999年5月至2009年5月27例经心脏超声检查确诊为心脏肿瘤患者的临床资料.男性20例,女性7例;年龄24 d～12.6岁,＜1岁者16例,占59.2%.22例为单发心脏肿瘤,5例为多发.其中22例因心律失常、心包积液、呼吸困难、晕厥等症状进行手术切除,5例未施行手术.根据肿瘤的具体位置选择不同的切口径路,14例完整切除肿瘤,8例部分切除;5例行二尖瓣整形,2例行三尖瓣整形.结果 术后肿瘤组织学结果:纤维瘤5例,横纹肌瘤8例,黏液瘤4例,毛细血管瘤3例,纤维肉瘤和卵黄囊瘤各1例.16例术后循环稳定;2例出现低心排血量,经治疗后心功能恢复;4例因严重低心排血量并发多器官功能衰竭死亡.18例术后随访1～10年,2例横纹肌瘤残余肿块缩小,1例消失;1例纤维肉瘤、1例血管瘤残余肿块未增大;黏液瘤术后无复发或远处种植转移.5例未手术者随访1～3年,其中2例无明显症状;1例左心室游离壁肿瘤因心律失常死亡,另1例仍存活;1例多发性心脏肿瘤伴低心排血量患者因心力衰竭死亡.结论 小儿原发性心脏肿瘤应采用个体化治疗原则,对有明显症状者应行手术治疗,对无明显症状者要密切随访.手术的目的 不是完整切除肿瘤,而是要恢复正常的血流动力学状态.

Abstract：

Objective To analyze the experience of treatment strategies for pediatric patients with primary cardiac tumors. Methods The clinical data of 27 patients with primary cardiac tumors which detected by echocardiography from May 1999 to May 2009 was analyzed retrospectively. There were 20 male and 7 female patients, aged from 24 d to 12. 6 years. There were 59. 2% less than 1 year old at the time of diagnosis. A single tumor were present in 22 cases and multiple in 5 cases. Surgery was performed for 22 patients due to the varied significant symptoms such as arrhythmia, pericardial effusion, swoon and congestive heart failure with dyspnoea. Five patients were discharged hospital without surgical treatment. The surgical approachs were adopted according to tumor location. Complete surgical resection was performed in 14 patients and partial resection in 8 patients. Seven patients were underwent valve reconstruction,5 involving the mitral valve and 2 involving the tricuspid valve. Results Histologic examination of the surgically resected tumors showed rhabdomyomas in 8 cases, fibromas in 5 cases, hemangiomas 3 cases,myxomas in 4 cases, fibrosarcoma in 1 case and yolk sac sarcoma in 1 case. Sixteen cases revealed stable haemodynamic status postoperative. Two cases occurred apparent symptoms of low cardiac output and significant arrhythmias, finally recovery after comprehensive treatment of restoration the heart function. There was a total of 4 patients in-hospital death following surgery due to multiorgan system failure. Of the 18 patients who survived after the surgery were followed up from 1 to 10 years, echocardiography showed the residual mass of the tumor with partial resection, rhabdomyoma diminishing in 2 patients and almost vanishing in 1 patient. The residual mass of one fibrosarcoma patient and one hemangioma patient were not increased. Patients with myxomas had no recur or systemic embolisation after the initial surgery. Five nonsurgical patients were followed up from 1 to 3 years, 2 patients without haemodynamic alterations,1 patients with giant tumor of left ventricular free wall was died of arrhythmia, the other one was alive; the patient of multiple cardiac tumor with low cardiac output was died of heart failure. Conclusions Despite the benign histology of most paediatric primary cardiac tumours, there may be significant associated with morbidity and occasional mortality. Therapy strategies should be individualised: surgery is indicated in cases with significant clinical symptoms and close follow-up is necessary for asymptomatic patients. Total resection is not the only therapeutic aim. Most important is the restoration of the normal haemodynamic heart function.