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目的:总结原发性心脏肿瘤外科诊治的经验。方法:回顾性分析1990年1月至2014年6月,我科收治的41例原发性心脏肿瘤患者临床资料。全部病例均经超声心动图检查,7例病人接受320排CT检查。左心房肿瘤30例,右心房肿瘤7例,右心室肿瘤3例,右心房至右心室肿瘤1例。其中38例接受体外循环下的外科治疗,急诊手术2例,限期手术15例,择期手术21例。3例疑诊为心脏恶性肿瘤,未行手术治疗。结果:手术病人无围手术期死亡,8例术后发生低心排综合征,1例发生呼吸衰竭。术后病理提示:黏液瘤33例;非黏液瘤良性肿瘤3例;恶性肿瘤2例,均为血管肉瘤。术后随访30例,随访率为78.9%。随访时间为5个月~10年,复发率为6.7%(2/30),远期死亡率为3.3%(1/30)。黏液瘤患者无复发和远期死亡。非黏液瘤良性肿瘤患者2例复发。恶性肿瘤患者1例术后8月全身转移死亡,1例术后失访。结论:超声心动图对原发性心脏肿瘤的诊断有重要作用,320排CT可提供更加直观的影像学资料。一旦确诊应限期手术治疗,可取得良好效果。
Objective: To summarize the experience of surgical diagnosis and treatment of primary cardiac tumors. Methods: The clinical data of 41 patients with primary cardiac tumors admitted to our department from January 1990 to June 2014 were retrospectively analyzed. All cases were echocardiographic examination, 7 patients underwent 320 row CT examination. Left atrial tumor in 30 cases, right atrial tumor in 7 cases, right ventricular tumor in 3 cases, right atrium to right ventricular tumor in 1 case. Among them, 38 cases underwent surgical treatment under cardiopulmonary bypass, 2 cases underwent emergency operation, 15 cases underwent scheduled operation and 21 cases underwent elective operation. 3 cases of suspected malignant heart disease, no surgical treatment. Results: There was no perioperative death in the surgical patients, 8 cases had low cardiac output syndrome after operation, and 1 case had respiratory failure. Postoperative pathology: 33 cases of myxoma; 3 cases of non-myxoma benign tumor; 2 cases of malignant tumor, all of angiosarcoma. Thirty patients were followed up for a follow-up of 78.9%. The follow-up time ranged from 5 months to 10 years. The recurrence rate was 6.7% (2/30) and the long-term mortality rate was 3.3% (1/30). Myxoma patients without recurrence and long-term death. Two cases of non-myxoma benign tumor recurrence. One patient with malignant tumor died of systemic metastasis in August after operation, and one patient was lost after operation. Conclusion: Echocardiography plays an important role in the diagnosis of primary cardiac tumors. 320-slice CT can provide more intuitive imaging data. Once the diagnosis should be scheduled surgery, can achieve good results.