心脏黏液瘤再次手术23例  

Reoperation for cardiac myxoma:report of 23 cases

作　　者：周明阳[1] 杨秀滨 华琨[1] 毛斌[1] 张良 孙东[1] 吴强[1] Zhou Mingyang;Yang Xiubin;Hua Kun;Mao Bin;Zhang Liang;Sun Dong;Wu Qiang(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Vessel Disease,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华胸心血管外科杂志》2021年第8期477-481,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结23例心脏黏液瘤术后复发再次进行手术治疗的经验。方法2002年1月至2018年12月,1106例心脏黏液瘤患者接受手术治疗,其中23例为复发后再次接受手术治疗患者,男10例,女13例,平均年龄(50.5±10.8)岁,二次手术22例,四次手术1例。合并二尖瓣关闭不全3例,合并三尖瓣关闭不全1例。纽约心功能分级Ⅰ~Ⅱ级20例,Ⅲ~Ⅳ级3例。设立同期心脏黏液瘤一次手术患者1083例为对照组,比较23例再次手术患者跟一次手术患者的手术时间、体外循环时间、主动脉阻断时间、ICU监护时间、呼吸机辅助呼吸时间、术后住院日、住院病死率以及出院时左心室射血分数。结果8例(34.8%)首次发病部位位于左心房房间隔,15例(65.2%)首次发病于左心房房间隔以外部位,复发部位:左心房17例(73.9%),左心室2例(8.7%),右心房3例(13.0%),右心室1例(4.3%),再次手术占同期心脏黏液瘤手术比例的2.1%,13例定期复查患者复发时间的中位数为24个月。同期二尖瓣置换2例,二尖瓣成形1例,三尖瓣成形1例。平均手术时间(3.9±2.8)h,体外循环(107.6±33.8)min,主动脉阻断(64.9±23.8)min,ICU监护(20.1±16.0)h,呼吸机辅助呼吸(16.9±8.5)h,出院时左心室射血分数0.51±0.10,术后住院(8.3±1.5)天。23例手术均顺利出院,无住院死亡患者,中位随访时间5(1~18)年,全因死亡1例(4.3%)。其中,再次手术患者ICU监护时间、呼吸机辅助呼吸时间、出院时左心室射血分数、术后住院日以及住院病死率较一次手术差异无统计学意义(P>0.05)。结论非典型心脏黏液瘤术后具有高复发倾向,首次手术后定期复查是早期发现复发以及避免并发症出现的必要手段,复发后再次手术治疗仍可以取得满意效果。Objective To summarize the experience of reoperation for 23 cases of cardiac myxoma recurrence.Methods From January 2002 to December 2018,1106 patients with cardiac myxoma underwent surgical treatment.Among them,23 patients underwent reoperation after recurrence.10 males and 13 females with an average age of(50.5±10.8)years old.There were 22 patients with secondary operation and 1 patient with four operations.3 cases with mitral insufficiency and 1 case with tricuspid insufficiency.There were 20 patients with NYHAⅠ-Ⅱand 3 patients withⅢ-Ⅳ.A total of 1083 patients with cardiac myxoma undergoing primary operation were selected as the control group.The operation time,cardiopulmonary bypass time,aortic clamping time,ICU monitoring time,ventilator assisted breathing time,postoperative hospital stay,in-hospital mortality and cardiac ejection fraction at discharge were compared between the two groups.Results 8 cases(34.8%)had the first onset in the left atrial septum,and 15 cases(65.2%)in other parts.Recurrence site:left atrium in 17 cases(73.9%),left ventricle in 2 cases(8.7%),right atrium in 3 cases(13.0%),right ventricle in 1 case(4.3%).Reoperation accounted for 2.1%of cardiac myxoma surgery in the same period.The median recurrence time of 13 patients was 24 months.During the same period,mitral valve replacement was performed in 2 cases,mitral valvuloplasty in 1 case and tricuspid valve plasty in 1 case.The average operation time was(3.9±2.8)h,cardiopulmonary bypass time was(107.6±33.8)min,aortic clamping time was(64.9±23.8)min,ICU monitoring time was(20.1±16.0)h,ventilator assisted breathing time was(16.9±8.5)h,cardiac ejection fraction at discharge was 0.51±0.10,postoperative hospital stay was(8.3±1.5)days.The median follow-up time was 5(1-18)years.One case(4.3%)died of all causes.There was no significant difference in ICU monitoring time,ventilator assisted breathing time,discharge cardiac ejection fraction,postoperative hospital stay and hospital mortality between reoperation patients and one oper

关 键 词：心脏黏液瘤 复发 非典型 心脏手术 

分 类 号：R732.1[医药卫生—肿瘤]