右侧心腔受累的静脉内平滑肌瘤病的外科治疗策略  

Surgical Treatment Strategies of Intravenous Leiomyomatosis with Right Cardiac Cavities Extension

作　　者：马国涛[1] 苗齐[1] 刘兴荣[1] 张超纪[1] 郑月宏[2] 邵江[2] 成宁海[3] 杜顺达[4] 刘剑州[1] 蒋超[5] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院心脏外科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院血管外科,北京100730 [3]中国医学科学院,北京协和医学院,北京协和医院妇产科,北京100730 [4]中国医学科学院,北京协和医学院,北京协和医院肝脏外科,北京100730 [5]中国医学科学院,北京协和医学院,北京协和医院外科,北京100730

出　　处：《中国医学科学院学报》2016年第4期438-443,共6页Acta Academiae Medicinae Sinicae

摘　　要：目的探讨右侧心腔受累的静脉内平滑肌瘤病的诊断与外科治疗策略。方法选取北京协和医院2002年11月至2015年1月收治静脉内平滑肌瘤延伸至右侧心腔患者30例,对以下变量进行分析:年龄、应用体外循环患者的体外循环时间、停循环时间、肿瘤起源情况、术中出血量、术后住院时间、住院费用、是否存在下肢水肿、是否进行异体输血、术后并发症、肿瘤残留及复发情况等。结果 30例患者双下肢水肿者13例,27例应用体外循环,平均体外循环时间为(106.9±53.7)min,21例采用深低温停循环技术,平均停循环时间为(28.2±11.6)min。30例患者中9例肿瘤起源于生殖静脉,13例起源于髂静脉,8例既起源于生殖静脉、也起源于髂静脉。患者的术中出血量平均为(2060.5±2012.3)ml,21例患者进行输血治疗,术后平均住院时间为(18.9±8.3)d,平均住院费用为(80 840.4±28 264.2)元。14例患者术后出现并发症,无严重术后并发症,无1例死亡,随访至今情况良好。结论明确诊断,提高对肿瘤延伸侵入腔静脉及右心房的警惕性,对于右侧心腔受累的静脉内平滑肌瘤病患者,采用合理的手术策略,能达到完整切除肿瘤,确保患者安全的良好临床效果。切除附件对抑制肿瘤生长和避免复发至关重要。Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis（ IVL） extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015. The following variables were studied： age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time, origins of IVL, blood loss, duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence. Results Thirteen of 30 patients reported double lower limb edema. The cardiopulmonary bypass was applied in 27 cases,and the average duration of cardiopul-monary bypass was（ 106. 9 ± 53. 7） min. Then,21 patients were treated with the deep hypothermic circulatory arrest,and the mean time was（ 28. 2 ± 11. 6） min. The tumors originated from the genital veins in 9 cases,the iliac vein in 13 cases,and both veins in 8 cases. The average intra-operative blood loss volume was（ 2060. 5 ±2012. 3） ml,and 21 patients received blood transfusion. The average hospitalization time was（ 18. 9 ± 8. 3）days and the average hospitalization expenses was（ 80 840. 4 ± 28 264. 2） RMB yuan. While 14 patients had postoperative complications,there was no serious postoperative complication or death. All patients have shown a favorable outcome. Conclusions Tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected in patients with multiple hysteromyoma. Successful therapy for IVL with right cardiac cavities extension is dependent on reasonable surgical treatment strategies. Surgical removal of the ovaries is vital to avoid IVL re-grow or recurrence.

关 键 词：静脉内平滑肌瘤病 右侧心腔 外科治疗策略 

分 类 号：R61[医药卫生—外科学]