64例右心房肿瘤的临床特点及外科治疗分析  

Clinical features and surgical treatment of right atrial tumors: a retrospective analysis of 64 cases

作　　者：潘文成 王学锋 冯泽洲 王咏 PAN Wencheng;WANG Xuefeng;FENG Zezhou;WANG Yong(Department of Cardiovascular Surgery,PLA Institute of Cardiovascular Surgery,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院全军心血管外科研究所,重庆400037

出　　处：《第三军医大学学报》2021年第16期1587-1592,共6页Journal of Third Military Medical University

摘　　要：目的探讨右心房肿瘤的临床特点、外科治疗效果及经验。方法收集2009年1月至2021年1月我科收治的64例右心房肿瘤的病例资料,总结分析其临床资料、手术要点、术后并发症及转移复发情况。结果本组总体良性肿瘤占比78.1%,恶性肿瘤占比21.9%;手术组良性肿瘤占比83.0%,恶性肿瘤占比17.0%。患者最常见的临床症状前三位依次为疲乏、胸闷胸痛或心前区不适感、面部或下肢水肿,最常见的术前合并症为房颤/房扑,其次为肺栓塞。住院总死亡率为3.1%,在院术后死亡率为1.9%。良性肿瘤患者中残留下腔静脉远端瘤栓无法取出1例;心律失常需介入手术干预1例;三尖瓣中至重度反流3例;转移性复发2例。接受手术的恶性肿瘤患者早期死亡1例,6例在半月到2年7个月间转移复发,2例失访。结论右心房肿瘤多为原发性良性肿瘤。手术治疗良性右心房肿瘤,即使对于复发病例,均安全且有效;选择性手术治疗恶性右心房肿瘤可改善血流动力学和临床症状,但总体预后不良。Objective To investigate the clinical characteristics of right atrial tumors and to analyze the experience and efficacy of surgical treatment.Methods The clinical data of 64 patients(37 females and 27 males,at a mean age of 47.0±16.4 years)with right atrial tumors admitted to our hospital from January 2009 to January 2021 were retrospectively collected and analyzed.The clinical features,surgery techniques adopted,postoperative complications and metastatic recurrence of patients were summarized in detail.Results Among all the 64 cases,benign tumors accounted for 78.1%and malignant tumors for 21.9%;while among the 53 patients who underwent surgical treatment,83.0%of the tumors were benign and 17.0%malignant.The top 3 most common clinical symptoms involved fatigue,chest tightness and pain or precordial discomfort,and facial or lower limbs edema.And the most frequent preoperative complications were atrial fibrillation/flutter,followed by pulmonary embolism.Moreover,the overall in-hospital mortality rate was 3.1%,and the postoperative mortality rate 1.9%.Among the patients with benign tumors,1 had residual tumor thrombus at the distal end of inferior vena cava,1 occurred arrhythmia requiring surgical intervention,3 developed moderate to severe tricuspid regurgitation,and 2 had metastatic recurrences.In the patients with malignant tumors who received surgery,1 died early postoperatively,6 developed metastatic recurrences between half a month and 2 years plus 7 months,and 2 cases were lost during follow-up.Conclusion Primary benign tumor is the major type of right atrial tumors.Surgical treatment for benign tumors is safe and effective,even in recurrent cases.Selective surgical treatment for malignant tumors can improve hemodynamics and clinical symptoms,though the overall prognosis tends to be poor.

关 键 词：心脏肿瘤 黏液瘤 心房 诊断 心脏外科手术 

分 类 号：R181.32[医药卫生—流行病学] R730.56[医药卫生—公共卫生与预防医学]