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目的:回顾性总结原发性心脏肿瘤103例的外科治疗效果。方法:根据病检结果分类,103例中良性肿瘤97例,占94.2;恶性肿瘤6例,占5.8。本组病例术前均行心脏彩超,怀疑恶性者行CT或核磁共振检查。所有良性肿瘤中,除1例平滑肌瘤由下腔静脉延伸至右房,仅部分切除外,其余均完全切除。同期行Dacron补片房间隔修补74例,三尖瓣瓣膜置换1例,二尖瓣整形6例,三尖瓣整形1例,同期行冠状动脉搭桥2例。恶性心脏肿瘤患者中,2例血管肉瘤患者,1例完全切除肿瘤,同期行右房-房间隔重建并行右房-上腔静脉人工血管连接术,并在术后接受局部放疗,另1例行部分切除及自体心包右心房修补;2例右室横纹肌肉瘤患者,行部分肿瘤切除术;2例肺动脉恶性间皮瘤累及肺动脉患者,在体外循环下经肺动脉切口清除肿瘤,疏通肺动脉直至肺门水平。结果:住院期间,全组仅死亡1例,其余患者均顺利出院。良性肿瘤在(2±1.7)年随访期内未发现复发者。6例恶性肿瘤患者中5例术后6个月内早期复发。结论:原发性心脏肿瘤的治疗应根据其恶性程度、来源、侵犯范围、大小来决定手术时机和方式;心脏良性肿瘤中最常见的是黏液瘤,手术应及时进行。发热及血沉增快并不是手术禁忌;术中应防止瘤体破碎,避免遗留肿瘤组织,应切除瘤蒂附着的房壁、房间隔甚至部分瓣膜,防止复发;心脏原发恶性肿瘤预后不良,往往难以完全切除,术后应辅以化疗或放疗。
Objective: To retrospectively summarize the surgical treatment of 103 cases of primary cardiac tumors. Methods: According to the results of disease examination, 103 cases of benign tumors in 97 cases, accounting for 94.2; 6 cases of malignant tumors, accounting for 5.8. The patients underwent preoperative echocardiography, suspected malignant CT or MRI. All benign tumors, in addition to a smooth leiomyoma from the inferior vena cava extending to the right atrium, only partial resection, the rest were completely removed. During the same period Dacron patch atrial septum repair 74 cases, tricuspid valve replacement in 1 case, mitral valve repair in 6 cases, tricuspid valve flap in 1 case, coronary artery bypass graft in 2 cases. In 2 patients with malignant cardiac tumors, 2 patients with angiosarcoma, 1 patient with complete resection of the tumor, and right atrial-atrial septal reconstruction with right atrium-superior vena cava graft in the same period underwent radiotherapy followed by local radiotherapy. Another patient underwent routine radiotherapy Partial resection and autologous pericardial right atrium repair; 2 cases of right ventricular rhabdomyosarcoma patients underwent partial tumor resection; 2 cases of pulmonary malignant mesothelioma involving the pulmonary artery patients, undergoing extracorporeal circulation via the pulmonary artery incision to clear the tumor, clear the pulmonary artery until the hilar level . Results: During the hospitalization, only 1 patient died in the whole group and the rest patients were discharged smoothly. No recurrence was found in benign tumors within 2 ± 1.7 years of follow-up. Five of 6 patients with malignant tumors had early recurrence within 6 months after operation. Conclusion: The treatment of primary cardiac tumors should be based on the degree of malignancy, the source, the extent of violations, the size to determine the timing and manner of surgery; benign tumors of the heart is the most common myxoma, surgery should be promptly carried out. Fever and ESR is not a taboo surgery; intraoperative should prevent the tumor broken, to avoid leaving the tumor tissue should be removed tumor pedicle attached to the wall, atrial septum or even part of the valve to prevent recurrence; poor prognosis of heart malignant tumors, often Difficult to completely resected, should be supplemented with chemotherapy or radiotherapy.