73例原发性心脏肿瘤的外科治疗与疗效分析

刘坦; 余云生; 黄浩岳; 叶文学; 华菲; 陈一欢; 范红友; 冀振春

doi:10.16766/j.cnki.issn.1674-4152.003413

73例原发性心脏肿瘤的外科治疗与疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003413

苏州大学附属第一医院心脏大血管外科，江苏苏州 215006

基金项目:

江苏省卫生健康委员会重点研究项目 ZDA2020017

详细信息

通讯作者:
刘坦，E-mail：liutan0211@163.com

中图分类号: R732.1 R654.2
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出版历程
- 收稿日期: 2023-08-11
- 网络出版日期: 2024-05-27

Surgical treatment and curative effect analysis of 73 cases of primary cardiac tumor

Department of Cardiac Vascular Surgery, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China

摘要

摘要: 目的总结73例原发性心脏肿瘤的外科治疗经验，提高心脏肿瘤的诊治水平。方法回顾性分析2018年1月—2022年11月在苏州大学附属第一医院心脏大血管外科手术治疗的73例心脏肿瘤患者，收集患者一般临床资料，分析其术前临床表现、术中手术入路的选择、肿瘤的位置及占比、术后肿瘤病理和预后。结果患者中30例表现为充血性心力衰竭，占比41.1%；合并栓塞史18例，占比24.7%；有2例表现为发热或全身症状，占比0.03%；8例合并心律失常，占比11.0%；无临床症状表现者15例，占比20.5%。本组患者黏液瘤63例(86.3%)，非黏液瘤性良性肿瘤8例(11.0%)，恶性肿瘤2例(2.7%)；来源于左心房者最多见，位于左心房者53例，右心房4例，左心室4例，右室流出道1例，左右心房2例，左房左室1例，累及二尖瓣4例，累及三尖瓣1例，位于肺静脉1例，位于下腔静脉1例，位于心包腔1例。全组患者有1例围手术期死亡，余患者无手术相关死亡。随访6个月~5年，平均随访34个月，失访1例，原发性心脏良性肿瘤患者无复发，2例恶性肿瘤患者分别于3个月、6个月死亡。结论原发性心脏肿瘤缺乏特征性临床表现，黏液瘤是最常见的原发性心脏肿瘤，外科手术切除是有效的治疗手段。
- 心脏肿瘤 /
- 黏液瘤 /
- 外科治疗
Abstract: Objective To summarize the experience of surgical treatment of 73 cases of primary cardiac tumors and improve the level of diagnosis and treatment of cardiac tumors. Methods A retrospective analysis was performed on 73 patients with cardiac tumors who were treated by cardiac macrovascular surgery in the First Affiliated Hospital of Soochow University from January 2018 to November 2022. General clinical data was collected, and their preoperative clinical manifestations, intraoperative surgical approach selection, tumor location and proportion, postoperative tumor pathology and prognosis were analyzed. Results A total of 30 patients showed congestive heart failure, accounting for 41.1%. There were 18 cases with embolism history, accounting for 24.7%. Two cases showed fever or systemic symptoms, accounting for 0.03%. Eight cases were complicated with arrhythmia (11.0%). Fifteen cases showed no clinical symptoms, accounting for 20.5%. In this group, there were 63 myxoma (86.3%), 8 non-myxomatous benign tumors (11.0%), and 2 malignant tumors (2.7%), most of which originated from the left atrium, 53 were located in the left atrium, 4 in the right atrium, 4 in the left ventricle, 1 in the right ventricular outflow tract, 2 in the left and right atrium, 1 in the left atrium and 1 in the left atrium, and 4 involved the mitral valve. Tricuspid valve was involved in 1 case, pulmonary vein in 1 case, inferior vena cava in 1 case, pericardial cavity in 1 case. In the whole group, 1 case died perioperatively, and the remaining patients had no surgery-related death. Follow-up ranged from 6 months to 5 years, with an average follow-up of 34 months, and 1 case was lost to follow-up. There was no recurrence of primary cardiac benign tumor, and 2 patients with malignant tumor died at 3 months and 6 months, respectively. Conclusion Primary cardiac tumors lack characteristic clinical manifestations. Myxoma is the most common primary cardiac tumor, and surgical resection is an effective treatment.
- Cardiac tumor /
- Myxoma /
- Surgical treatment

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表 1 73例心脏肿瘤患者临床表现

Table 1. Clinical manifestations of 73 patients with cardiac tumors

临床表现	例数(%)
充血性心力衰竭	30(41.1)
栓塞	18(24.7)
发热或全身症状	2(2.7)
心律失常	8(11.0)
无症状	15(20.5)
NYHA分级
＜Ⅲ级	45(61.6)
≥Ⅲ级	28(38.4)
注：NYHA分级为纽约心脏协会(New York Heart Association, NYHA)心功能分级。

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表 2 73例心脏肿瘤患者的发病位置(例)

Table 2. Localization of cardiac tumors in 73 patients (cases)

肿瘤性质	左心房	右心房	左心室	右心室	左右心房	左房左室	右室流出道	二尖瓣	三尖瓣	肺静脉	下腔静脉	心包腔	合计
黏液瘤	52	3	0	0	1	1	0	4	1	0	1	0	63
非黏液瘤性良性肿瘤	1	1	4	0	0	0	1	0	0	0	0	1	8
恶性肿瘤	0	0	0	0	1	0	0	0	0	1	0	0	2
合计	53	4	4	0	2	1	1	4	1	1	1	1	73

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表 3 73例心脏肿瘤患者的肿瘤病理类型

Table 3. Pathological classifications of cardiac tumors in 73 patients

肿瘤病理	例数(%)	男性(例)	女性(例)
黏液瘤	63(86.3)	23	40
血管瘤	3(4.1)	1	2
脉管瘤	1(1.4)	1	0
脂肪瘤	2(2.7)	0	2
乳头状弹力纤维瘤	1(1.4)	0	1
间叶源性肿瘤	1(1.4)	1	0
肉瘤	2(2.7)	1	1
合计	73(100.0)	27	46

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