心脏黏液瘤的外科治疗

目的 探讨心脏黏液瘤的诊断和治疗经验。方法 回顾性分析自1995年10月～2001年10月收治的83例心脏黏液瘤病例(其中左心房黏液瘤57例,右心房黏液瘤19例,左心室黏液瘤2例,右心室黏液瘤5例)。术前经彩色超声心动图确诊,均在体外循环下行黏液瘤摘除术,同期行二尖瓣成形术8例,二尖瓣机械瓣置换术3例,三尖瓣成形术62例,三尖瓣机械瓣置换术1例,房间隔缺损修补术6例,隔膜型主动脉瓣下狭窄解除术1例。结果 无围术期及手术死亡,随访72例,时间1个月到6年,心功能(NYHA分级):Ⅰ级51例,Ⅱ级11例,Ⅲ级4例,1例发生脑梗死死亡,1例死于车祸,1例死因不明,3例复发再次手术,复发率4.2％。结论 心脏黏液瘤一经确诊应尽快手术,手术效果满意,复发率低,彩色超声心动图对诊断及术后随访有重要作用,应注意术后随访。

Surgical treatment of cardiac myxomas

Objective To review the clinical experience of diagnosis and surgical treatment of cardiac myxoma.Methods 83 patients with cardiac myxoma(57 left atrial myxomas, 19 right atrial myxomas,2 left ventricle myxomas and 5 right ventricle myxomas) were analyzed retrospectively from Oct. 1995 to Oct. 2001. The diagnosis was confirmed by echocardiography before operation. All patients underwent excision of myxoma using cardiopul-monary bypass. Associated procedures were mitral valvuloplasty in 8 cases, mechanic mitral valve replacement in 3 cases,tricuspid valvuloplasty in 62 cases,bicuspid valve replacement in 1 case,atrial septal defect repair in 6 cases and resection of membranous subaortic stenosis in 1 case. Results There was no hospital mortality. Excision of the tumor resulted in marked symptomatic improvement. The postoperative follow-up were known for 72 of 83 patients and follow-up interval ranged from one month to six years. 3 patients had tumor recurrence and received reopera-tion.The rate of recurrence was 4.2% .Conclusion Surgical resection of cardiac myxomas is a safe and effective treatment with a low risk of recurrence and is imperative following the diagnosis. Echocardiography is the most useful diagnostic screening tool in the diagnosis and postoperative follow-up for patients with cardiac myxomas. Long follow-up is necessary.