原发性心脏恶性肿瘤的诊断与外科治疗经验

目的总结原发性心脏恶性肿瘤的诊断和外科治疗经验。方法2003年1月至2007年12月手术治疗4例原发性心脏恶性肿瘤,其中男1例,女3例,年龄26~43岁,平均35岁,本组除1例右心房肿瘤广泛侵犯右房室环及心包仅做活检外,其余3例均在全麻低温体外循环辅助下行肿瘤切除术,根据肿瘤的部位及侵润程度,完整切除2例,姑息切除1例,同期行室间隔修补、肺动脉成形1例,二尖瓣置换1例,三尖瓣成形1例。结果全组无围术期死亡。单纯探查活检术的患者2个月后死于心力衰竭;1例右心室梭形细胞肉瘤术后辅助放、化疗,术后18个月肿瘤复发死于右心衰竭;1例左心房恶性间皮瘤手术后3个月死于双肺广泛转移;1例左心房梭形细胞肉瘤术后随访5个月无肿瘤复发。结论原发心脏恶性肿瘤预后欠佳,早期诊断,及时手术治疗辅以综合治疗可望改善预后。

Diagnosis and surgical management of primary cardiac malignant tumor

Objective To summarize the experience in diagnosis and surgical treatment of primary cardiac malignant tumor.Methods Four patients aged from 26 to 43 years old were diagnosed primary cardiac malignant tumor between January 2003 and December 2007,including one male and three females.One underwent open chest biopsy only because the tumor had invaded right atrioventricular ring and pericardium,and the other three patients received tumor resection under hypothermic cardiopulmonary bypass(CPB),including 2 complete resection of tumor and 1 partial resection.Meanwhile,1 received ventricular septum repair plus pulmonary artery shaping,1 had mitral valve replacement and 1 had tricuspid valvuloplasty.Results There was no perioperative death.The patient who underwent biopsy only died of heart failure two months later.One patient died of right heart failure caused by tumor recurrence 18 months after comprehensive therapy.One died of pulmonary metastasis 3 months after operation and the last one showed no tumor recurrence 5 months after surgery.Conclusion The prognosis of primary cardiac malignant tumor is very poor.Early diagnosis and operation combined comprehensive therapy may improve the prognosis.