右房黏液瘤的外科治疗体会及近中期临床疗效观察

  目的  探讨右房黏液瘤患者的临床特点及预后，总结外科治疗经验。  方法  自2008年1月—2018年12月共12例右房黏液瘤患者于安徽医科大学第一附属医院行浅低温体外循环下右房黏液瘤切除术，男性6例，女性6例，年龄为18~75(54.17±16.75)岁。其中正中开胸心脏停跳下手术11例，达芬奇机器人辅助心脏不停跳手术1例。回顾性分析其临床资料，总结右房黏液瘤在全部心脏黏液瘤中的比率、术前临床特征、手术技巧、瘤蒂附着部位、术后近中期疗效。  结果  右房黏液瘤占全部心脏黏液瘤的10.53%，瘤蒂最常见的附着部位是房间隔；全组12例手术均成功完成，手术时间为130~255(180.25±40.53)min，体外循环时间为30~72(49.17±14.33)min，中位升主动脉阻断时间为20.00(18.00~42.00)min，无围术期死亡，围术期全组患者均未出现低心排综合征、呼吸功能不全、急性肾功能不全、脑血管意外、恶性心律失常、肺栓塞等严重并发症。对9例(75.00%)患者随访12~109(44.56±30.59)个月，无死亡病例及肿瘤复发，心功能均恢复至Ⅰ~Ⅱ级(NYHA分级)。  结论  右房黏液瘤临床少见，一经确诊即应尽早手术，手术成功的关键在于体外循环的顺利建立以及彻底的心腔探查，外科治疗近中期疗效满意，远期预后有待进一步随访。 

Surgical experience and clinical effect observation of the resection of right atrial myxomas

  Objective  To investigate the clinical features and prognosis of right atrial myxomas and summarise the experience of surgical treatment.  Methods  From January 2008 to December 2018, 12 cases (6 males and 6 females) of right atrial myxomas underwent surgical resection under mild hypothermic cardiopulmonary bypass (CPB). The mean age was 18.00-75.00 (54.17±16.75) years. Amongst them, surgical resection was performed on arrested heart through median sternotomy in 11 cases, and robot-assisted surgery was performed on a beating heart in 1 case. Through retrospective analysis of the clinical data, the clinical characteristics, incidence, intraoperative technique, attachment site and short-term and middle-term surgical outcomes of right atrial myxomas were summarised.  Results  Right atrial myxomas comprised only 10.53% of all sporadic myxomas. The most common attachment site of right atrial myxomas was the atrial septum. All operations were successfully performed with no operative death or fatal postoperative complications such as low cardiac output syndrome, acute respiratory insufficiency, acute renal failure, stroke, malignant arrhythmia and pulmonary embolism. The operative time was 130-255 (180.25±40.53) min. The CPB time was 30-72 (49.17±14.33) min. The median aortic cross-clamping time was 20.00(18.00-42.00)min(range, 15-49 min). Nine patients (75.00%) were followed up for 12-109 (44.56±30.59) months. No deaths or recurrence occurred. The cardiac functions of all patients in the follow-up were class Ⅰ- Ⅱ (NYHA).  Conclusion  Right atrial myxoma is clinically rare. Once diagnosed, operation should be the first choice of treatment. The key to the success of the operation is the establishment of CPB and careful explorations to the cardiac chambers. The short-term and middle-term outcomes of surgical resection were satisfactory. However, long-term outcomes also need to be further observed.