右心室肿瘤手术治疗经验

目的：总结右心室肿瘤的手术治疗经验。 方法：回顾性分析我院2009年7月至2016年12月共20例进行右心室肿瘤切除术患者的临床资料。结果：男性13例，女性7例，平均年龄35.9±22.5(岁)，良性肿瘤19例，恶性肿瘤1例，心内膜肿瘤14例，心肌间肿瘤3例，心外膜肿瘤3例。20例患者均采取正中开胸，在体外循环下完成手术，根治性切除15例，姑息性切除5例，同期行三尖瓣系统修复6例，平均转机时间85.6±38.2分钟，平均主动脉阻断时间63.3±32.5分钟，手术相关并发症1例，平均术后住院时间8.3±2.0天。平均随访时间38.9±31.9月，随访过程中恶性肿瘤患者死亡，根治性切除组有1例复发，复发率6.7%(1/15)。右心室心肌间肿瘤与心外膜肿瘤相较于心内膜肿瘤更不易于进行根治性切除 (p=0.026)。姑息性切除术会延长术后住院时间(p=0.001)。结论：手术是治疗右心室肿瘤的主要方法，肿瘤根治性切除预后较好，姑息性切除和恶性肿瘤预后较差，且姑息性切除术会延长患者术后住院时间。右心室肿瘤切除的同时需要注意保护三尖瓣功能，必要时应积极进行三尖瓣的修复。关键词：心脏肿瘤；右心室；手术

Experiences in surgical treatment of right ventricular tumors

Objective To summarize the experiences in surgical treatment of right ventricular tumors. Methods Clinical data of 20 patients with surgical resection of right ventricular tumor were analyzed retrospectively from July 2009 to December 2016. Results There were 13 male and 7 female with the average age of (35.9±22.5) years old. It included 19 benign tumors, 1 malignant tumor, 14 endocardial tumors, 3 intramyocardial tumors and 3 epicardial tumors. All patients underwent surgery through median sternal incision, with complete resection in 15 cases and partial resection in 5 cases. Concomitant tricuspid valve repair was performed in 6 cases. Average extracorporeal circulation time was 85.6±38.2min and the blocking time was 63.3±32.5min. Surgical complication was in 1 case. Average postoperative hospitalization was 8.3±2.0 days. The patients were followed up for 38.9±31.9 months with one death in malignant patient and one recurrence in complete resection group(1/15,6.7%). The intramyocardial tumor and epicardial tumor were more difficult to complete resection than the endocardial tumor(p=0.026). Partial resection prolonged postoperative hospital stay (p=0.001).Conclusion Surgery is the main method to treat right ventricular tumor. There has good prognosis with complete resection, while poor prognosis with malignant tumor and partial resection. Partial resection will prolong postoperative hospital stay. We should be taken care to protect tricuspid valve function in the operation of right ventricular tumor, and should be active in the repair of tricuspid valve when necessary.