原发性心脏肿瘤的诊断和外科治疗

目的 总结原发性心脏肿瘤诊断和外科治疗的经验。方法 回顾分析1980年1月至2005年1月间112例原发性心脏肿瘤患者的临床资料,其中心脏黏液瘤98例,心脏非黏液瘤性良性肿瘤3例,原发性心脏恶性肿瘤11例。心脏黏液瘤和非黏液瘤性良性肿瘤行肿瘤切除术;11例原发性心脏恶性肿瘤中,6例行肿瘤切除术,3例行姑息性手术,2例行单纯心包引流术。全组同期行二尖瓣置换术2例,二尖瓣成形术4例,三尖瓣成形术33例。结果 术后早期生存108例,死亡4例,死亡率为3．6％。4例死亡患者中,2例黏液瘤患者分别因恶性心律失常和低心排于术后第2、7天死亡,1例原发性心脏恶性肿瘤患者术后第3天死于低心排,1例原发性心脏恶性肿瘤患者术后3周死于肝、肾功能衰竭。术后76例黏液瘤患者获得随访,随访时间3个月至17年,平均6．4年,未见复发。非黏液瘤性良性肿瘤3例随访结果与黏液瘤相似。11例原发性恶性肿瘤患者中,10例在术后1年内死亡;1例现术后11个月健在,尚无肿瘤复发。结论 原发性心脏肿瘤患者早期准确诊断,积极手术治疗,其良性肿瘤患者几乎可以达到治愈的目;而恶性肿瘤患者预后很差,手术可减轻症状,并延长患者生存期。

Diagnosis and surgical management of primary cardiac neoplasms

Objective To review and summarize the experience in diagnosis and surgical management of primary cardiac neoplasms. Methods 112 patients with primary cardiac neoplasms were treated surgically from Jan. 1980 to Jan. 2005. Those tumors were grouped into three categories: myxomas (98) , benign nonmyxomas (3), and malignant tumors(11). Five of 11 malignant tumor patients underwent biopsy or palliative operation, the other patients received complete excision. Mitral valve replacement were done simultaneously in 2 of these patients, mitral valve repair in 4 and tricuspid valvoplasty in 33. All patients' diagnosis was confirmed by echocardiography. Results 108 patients survived the operation and 4 patients died postoperatively. The hospital mortality was 3. 6% (4/112). Two patients developed poor left ventricular function postoperatively and died at the third and the seventh postoperative day due to low cardiac output. One patient developed and died of progressive hepatic and renal function failure postoperatively. Another one patient died of severe arrhythmia. Mean follow-up of 76 myxoma patients who are still alive was 6.4 years (range, 3 month to 17 years). Fifty-five patients still had heart function in New York Heart Association class I and 21 in class II at the end of follow-up without any evidence of recurrance. The follow-up results of benign nonmyxomas were similar to those of myxomas. Mean follow-up of all survived malignant tumor patient was 6 months (range, 2 months to 12 months). Ten of them died of recurrence or metastasis within 1 year postoperatively except only one still alive. Conclusion Surgical resection, whenever possible, is the first treatment choice for all kinds of primary cardiac tumors. Surgical resection of myxoma and benign nonmyxoma can give excellent long-term results which may lead to eventual cure of myxoma and benign nonmyxoma. For malignant tumor patient, surgical treatment is only palliative and to prolong the life of patients.