右心系统肿瘤临床特征及经胸超声心动图的诊断价值

目的分析右心系统肿瘤的临床特征，并探讨经胸超声心动图（TTE）在其诊断中的应用价值，以提高TTE对右心系统肿瘤的诊断准确率。方法回顾性分析武汉亚洲心脏病医院2004年1月-2013年3月临床初步诊断为右心系统肿瘤并经外科手术治疗的27例术前TTE结果及临床特征，并与手术及病理结果进行对照分析。结果27例中，原发心脏肿瘤23例（85．2％），其中良性17例（73．9％），恶性6例（26．1％）；继发性肿瘤4例（14．8％），其中良性3例，为静脉内平滑肌瘤累及右心系统；恶性1例，为未分化型甲状腺癌转移至右心房及房间隔、左心房。TTE诊断与手术及病理结果相符24例，漏诊1例，误诊4例，其敏感性为96．3％（26／27），特异性为85．2％（23／27）。结论右心系统肿瘤恶性病变发生率较高，TTE对右心系统肿瘤的诊断及良恶性判断具有重要价值。超声医师需紧密结合患者病史及临床症状、体征进行全方位扫查，以提高TTE的诊断准确率。

Clinical Features and Diagnostic Value of Transthoracic Echocardiography of Right Heart Tumors

Objective To analyze the clinical features of right heart tumors, and to explore the diagnostic value of transthoracic echocardiography （TTE） in order to improve the diagnostic accuracy of the right heart tumors by TTE. Methods Clinical features and the preoperative TTE results of 27 patients who had been preliminarily diagnosed as hav- ing right heart tumors and underwent operation in Wuhan Asia Heart Hospital during January 2004 and March 2013 were retrospectively analyzed compared with the surgical and pathological results. Results Among the 27 patients, 23 pa- tients （85.2%） were confirmed as having primary heart neoplasms, including 17 （73.9%） benign and 6 （26.1%） ma- lignant; 4 patients （ 14.8% ） were confirmed as having secondary neoplasm including 3 benign which were the intrave- nous leiomyomatosis that affected the right heart, and 1 malignant which was undifferentiated thyroid carcinoma metasta- sized to right atrium, atrial septum and left atrium. The diagnosis by TTE was consistent with surgical and pathological re- sults in 24 patients, 1 patient missed diagnosis, and 4 were misdiagnosed by TTE. The sensitivity rate was 96.3% （26/ 27） , and the specificity rate was 85.2 % （23/27）. Conclusion The malignant incidence rate of the right heart tumors is high, and TTE has a great value in diagnosis and differential diagnosis of benign or malignant right heart tumors. In or- der to further improve the diagnostic accuracy, the sonographers should make comprehensive examinations based on the patientb medical history, clinical symptoms and signs during diagnosis.