心内占位病变患者的诊断和外科治疗（附47例分析）

目的：总结心内占位病变诊断和外科治疗经验。方法：1995年6月至2011年4月我院收治的47例心内占位病变患者的临床资料，其中良性肿瘤43例（91．4％），均为粘液瘤，分布于左房41例，右房1例，右室1例；恶性肿瘤2例，分别为右室横纹肌肉瘤和左房肺动脉内膜肉瘤；左室附壁血栓1例；左心耳内翻1例。所有患者均在中度低温体外循环下手术，同期行二尖瓣成形术2例，三尖瓣成形术1例。结果：1例粘液瘤术后2年复发，分布于左房及右房，再次手术切除。2例恶性肿瘤均于术后6个月内死亡。其余心内占位病变恢复良好。结论：典型粘液瘤经超声心动图即可确诊，非典型粘液瘤及其它非典型部位的心内占位病变需借助CT、MRI及PET进一步明确诊断。心脏占位病变一经诊断应尽快手术，即使发生脑梗塞也非手术禁忌，良性肿瘤预后较好．恶性肿瘤预后较差。

ANALYSIS OF DIAGNOSIS AND SURGICAL MANAGEMENT OF 47 CASES OF INTRACARDIAC SPACE-OCCUPYING LESIONS

Objective： To summarize the experience of diagnosis and surgical treatment of intracardiac space-occupying lesions. Methods： 47 cases of cardiac lesions were treated in our hospital from June 1995 to April 2011. Among them,43 cases were benign tumors （91.4%） and all were cardiac myxomas. The myxomas located in left atrium in 41 cases , right atrium in 1, right ventricle in 1.Two cases of malignant tumors were rhabdomyosarcoma of right ventricular and pulmonary artery intimal sarcoma of left atrial, 1 case was left ventricular mural thrombus, 1 case was inverted left atrial appendage. All the patients underwent surgical treatment under cardiopulmonary bypass. 2 cases underwent mitral valve plasty ,1 case underwent tricuspid valve plasty. Results： One case of myxoma was recurrent after 2 years,which were located in left atrium and right atrium, and underwent another surgical treatment. 2 cases of malignant tumors were dead within 6 months after surgery, and the remaining heart space-occupying lesions recovered well. Conclusion： Typical myxoma can be diagnosed by echocardiography, atypical myxoma and lesions at atypical parts of heart requires the use of CT, MRI and PET to confirm the diagnosis. The cardiac lesions need surgery as soon as possible after diagnosis, even if the occurrence of cerebral infarction is not a surgical contraindication. Benign tumor has good prognosis, but malignant tumor has the poor prognosis.