左心室肿瘤的诊断与手术治疗(附5例报告)

目的 探讨左心室肿瘤的临床特点、诊断和治疗方法.方法和结果 回顾性分析1999年1月至2012年5月在第二军医大学长海医院手术治疗的左心室肿瘤患者的临床资料.共收治5例患者,占同期手术治疗的心脏肿瘤患者的3.55％(5/141).术前均经超声心动图明确诊断.3例采用胸部正中切口,2例采用左胸前外侧切口.3例完整切除,1例部分切除,1例仅取活检.病理结果显示黏液瘤、横纹肌肉瘤、海绵状淋巴管瘤、乳头状弹力纤维瘤、肌间血管瘤各1例.无手术死亡,术后恢复良好.随访4～80个月(平均30个月),无死亡.黏液瘤患者完整切除后38个月后复发,再次手术切除后未见复发；横纹肌肉瘤患者仍存活,无明显不适；余患者复查无复发和转移.结论 左心室肿瘤多为良性,心脏超声是最重要的诊断工具,恶性肿瘤预后差,良性肿瘤手术效果良好.

Diagnosis and surgical treatment of cardiac tumors of the left ventricle: a report of 5 cases

Objective To discuss the clinical features, diagnosis and surgical treatment of the primary left ventricular tumors. Methods and results The clinical data of 5 patients with primary left ventricular tumors, who were surgically treated in Changhai Hospital from Jan., 1999 to May,2012, were retrospectively analyzed. The 5 patients accounted for 3.55% (5/141) of patients who were surgically treated for cardiac tumors in the same period. All the 5 cases were diagnosed with echocardiography before treatment. Median sternotomy was performed in 3 cases and left anterolateral thoracotomy in 2 cases. Complete resection of tumor was performed in 3 cases and subtotal resection in 1 case; only biopsy was obtained in the last case. The pathological diagnoses included myxoma, rhabdomyosarcoma, cavernous lymphangioma, papillary elastic fibroma, and intermuscular hemangioma. There was no operative death, and the postoperative course was uneventful. The patients were followed up for 4-80 months (a mean of 30 months) and there was no death. The patient with myxoma had recurrence 38 months after surgery, and there was no recurrence after reoperation. The case with rhabdomyosarcoma survived well; other patients showed no recurrence or metastasis. Conclusion Primary left ventricular tumors are genearally benign. Echocardiography is the most important diagnosis method. The prognosis of malignant left ventricular tumor is poor. The surgical results of left ventricular benign tumors are satisfactory.