右心系统子宫静脉平滑肌瘤临床分析  

Clinical analysis of intravenous-cardiac leiomyomatosis

作　　者：赵洋[1] 黄柱辉 付威 刘韬帅[1] 董然[1] Zhao Yang;Huang Zhuhui;Fu Wei;Liu Taoshuai;Dong Ran(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中华医学杂志》2020年第22期1741-1744,共4页National Medical Journal of China

摘　　要：目的总结右心系统子宫静脉平滑肌瘤患者的发病特点、诊疗方式及预后情况,为临床诊治提供参考。方法回顾性分析北京安贞医院心脏外科2009年11月至2019年7月收治的22例患者的临床资料,并长期随访评价预后。结果22例患者均为女性,年龄(48.1±6.3)岁。患者缺乏特异性临床表现。14例既往有子宫肌瘤病史,12例已行子宫切除,5例既往流产史。20例接受手术治疗,其中一期手术15例,分期手术5例,心脏停跳下切除肿瘤10例,同期行三尖瓣成形术1例。术后早期无死亡,术后早期并发症包括深静脉血栓2例、二度Ⅱ型房室传导阻滞1例、中-大量胸腔积液1例和切口感染1例;术后3年死亡1例,死于肿瘤复发导致的循环衰竭,其余患者生活质量良好,心功能均为Ⅰ~Ⅱ级,无复发及转移。结论右心系统子宫静脉平滑肌瘤缺乏特异性临床表现,早期发现是诊疗的关键,手术切除疗效确切,可取得较好的生活质量和中远期存活率。Objective To summarize the clinical characteristics,treatment and prognosis of patients with right intravenous-cardiac leiomyomatosis,and provide references for clinical diagnosis and management.Methods The clinical data of 22 patients who were admitted to Department of Cardiac Surgery in Beijing Anzhen Hospital from November 2009 to July 2019 were retrospectively reviewed.The long-term prognosis of the patients was also evaluated.Results All patients were women,with an age of(48.1±6.3)years.The clinical manifestations of patients lacked specificity.Among them,14 patients had a history of uterine leiomyoma,12 had hysterectomy,and 5 had abortions.Twenty patients underwent tumor resection.One-stage operation was performed in 15 cases,while staging surgery was performed in 5 cases.Ten cases underwent tumor resection under cardiopulmonary bypass.One case underwent a tricuspid valve annuloplasty at the same time.There was no death early in postoperative period.Early complications included deep venous thrombosis(2 cases),typeⅡatrioventricular block(1 case),pleural effusion(1 case)and incision infection(1 case).In the long-term follow-up(3 years),one case died of tumor recurrence-associated circulatory failure.Among the rest of the patients,the quality of life was satisfying,and cardiac function was between gradeⅠandⅡ,with no recurrence or metastasis.Conclusions Patients with intravenous-cardiac leiomyomatosis are lack of specific manifestations.Early diagnosis is crucial for the treatment of this disease.Tumor resection is an effective treatment,which can improve the quality of life and long-term survival of patients.

关 键 词：心脏肿瘤 静脉平滑肌瘤 预后 

分 类 号：R737.33[医药卫生—肿瘤] R732.1[医药卫生—临床医学]