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目的总结原发性心脏肿瘤的外科治疗经验,以提高手术疗效。方法回顾性分析1980年6月至2008年12月中国医科大学附属第一医院收治的263例原发性心脏肿瘤患者的临床资料,其中男90例,女173例;年龄10~79岁(41±13岁)。良性肿瘤241例,其中良性粘液瘤240例,纤维瘤1例;恶性肿瘤22例,其中恶性粘液瘤7例,恶性间皮瘤4例,血管肉瘤5例,横纹肌肉瘤1例,肺动脉内膜肉瘤1例,平滑肌肉瘤1例,炎症性恶性纤维组织细胞瘤1例,恶性淋巴瘤1例,滑膜肉瘤1例。手术完整摘除肿瘤252例(恶性肿瘤11例),局部切除肿瘤5例(均为恶性肿瘤),开胸探查取病理活组织检查6例(均为恶性肿瘤)。同期行冠状动脉旁路移植术(CABG)5例,二尖瓣置换术5例,二尖瓣成形术4例,三尖瓣成形术9例,三尖瓣生物瓣置换术1例,主动脉根部及肺动脉成形术1例,肺动脉瓣置换术1例,肺动脉主干及左右肺动脉人工血管加肺动脉瓣置换术1例,肺动脉切开取栓术1例,经股动脉取瘤栓术5例。结果围术期死亡7例(良性粘液瘤6例、恶性粘液瘤1例),其中术中不能停体外循环2例,术后发生低心排血量、心室颤动3例,呼吸、循环衰竭1例,大面积脑出血1例;其余患者无并发症发生。随访247例(良性肿瘤229例,恶性肿瘤18例),随访时间3个月~28年,失访9例(良性肿瘤6例、恶性肿瘤3例)。随访期间良性粘液瘤复发4例,均再次手术治疗;良性肿瘤患者死亡13例(心源性猝死6例、脑卒中2例、肺癌1例、不明原因4例),其余216例均生存。随访期间恶性肿瘤患者死亡15例,术后生存时间为1~4年,死于肿瘤复发或转移11例,心力衰竭和恶病质各2例。结论原发性心脏肿瘤一经确诊应尽早手术治疗,良性肿瘤手术效果好,恶性肿瘤术中应尽量切除肿瘤。
Objective To summarize the experience of surgical treatment of primary cardiac tumors in order to improve the curative effect. Methods The clinical data of 263 patients with primary cardiac tumors who were admitted to the First Affiliated Hospital of China Medical University from June 1980 to December 2008 were retrospectively analyzed. There were 90 males and 173 females, aged from 10 to 79 years old ± 13 years old). Malignant tumors in 22 cases, including 7 cases of malignant myxoma, 4 cases of malignant mesothelioma, 5 cases of angiosarcoma, 1 case of rhabdomyosarcoma, pulmonary arteriosclerosis 1 case, 1 case of leiomyosarcoma, 1 case of inflammatory malignant fibrous histiocytoma, 1 case of malignant lymphoma and 1 case of synovial sarcoma. 252 cases of complete tumor removal (11 cases of malignant tumors), 5 cases of locally resected tumors (all of which were malignant tumors) and 6 cases of pathological biopsy (all of them were malignant tumors) under open chest exploration. In the same period, 5 patients underwent coronary artery bypass grafting (CABG), 5 patients underwent mitral valve replacement, 4 patients underwent mitral valve operation, 9 patients underwent tricuspid valve plasty, 1 patient underwent tricuspid valve replacement, 1 case of root and pulmonary angioplasty, 1 case of pulmonary valve replacement, 1 case of pulmonary artery trunk and left and right pulmonary artery with pulmonary valve replacement, 1 case of pulmonary embolectomy and 5 cases of tumor embolization via femoral artery. Results Perioperative deaths in 7 cases (benign myxoma in 6 cases, 1 case of malignant myxoma), which can not stop the surgery in 2 cases of external circulation, postoperative low cardiac output, ventricular fibrillation in 3 cases, respiratory failure, circulatory failure 1 Case, a large area of cerebral hemorrhage in 1 case; the remaining patients without complications. A total of 247 patients (229 benign and 18 malignant) were followed up for 3 months to 28 years. Nine patients were lost to follow-up (6 benign tumors and 3 malignant tumors). In the follow-up period, 4 cases of benign myxoma recurred. All the patients were reoperated. Thirteen patients died of benign tumor (6 cases of sudden cardiac death, 2 cases of stroke, 1 case of lung cancer, 4 cases of unknown cause). The remaining 216 cases all survived. During follow-up, 15 patients died of malignant tumor, the survival time was 1 to 4 years, died of tumor recurrence or metastasis in 11 cases, heart failure and cachexia in 2 cases. Conclusion Primary cardiac tumors should be surgically treated as soon as they are diagnosed. Surgical treatment of benign tumors is effective. Malignant tumors should be resected in operation.