原发性心脏瓣膜肿瘤10例临床分析  

Clinical analysis of ten primary cardiac valve tumors

作　　者：黄志雄[1] 孙立忠[1] 杜茗[1] 王宏月 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管医院外科,北京100037

出　　处：《中华外科杂志》2004年第4期230-232,共3页Chinese Journal of Surgery

摘　　要：目的　分析原发性心脏瓣膜肿瘤的临床特征和外科治疗的远期效果。方法　回顾性总结 1983年 11月至 2 0 0 2年 11月在阜外心血管病医院行原发性心脏瓣膜肿瘤手术治疗的 10例患者的临床经验和远期结果。结果　本组原发性瓣膜肿瘤占心脏肿瘤的 2 6 5 % (10 / 378) ,其手术约占所有心脏手术的 1/ 4 0 0 0。 10例中男性 5例、女性 5例 ,年龄 2～ 6 6岁 ,平均 30岁。所有患者均有症状 ,临床表现为活动后心慌、气促 7例 ,脑血管栓塞症状 2例 ,紫绀 1例。术前超声心动图检查确诊 8例 ,术中确诊 2例。均在全麻、低温体外循环下行肿瘤切除。良性肿瘤 8例 ,恶性肿瘤 2例。术后早期恢复均顺利 ,晚期死亡 3例。死亡病例中 ,1例为三尖瓣囊性畸胎瘤患者 ,术后 2个月死于电解质平衡紊乱所致的心律失常 ;2例为二尖瓣恶性肿瘤 ,其中 1例术后 11个月死于肿瘤局部复发所致的心功能衰竭 ,另 1例术后 12个月死于肿瘤脑转移。长期生存的 7例均为瓣膜良性肿瘤患者 ,随访 8个月～ 19年 ,平均随访 5 7年。所有患者活动量恢复正常 ,心功能均为Ⅰ级。最后一次超声心动图检查均未见肿瘤局部复发。结论　瓣膜良性肿瘤手术切除后近、远期结果良好。恶性瓣膜肿瘤的预后很差。Objective To investigate the clinical characteristics of primary valve tumors and the late surgical results of their resection Methods We reviewed our clinical experience with the surgical treatment of ten primary valve tumors at Fuwai Hospital between November 1983 and November 2002 Results In this series,cardiac valve tumors constituted 2 65%(10/378) of all primary cardiac tumors,and the incidence of primary valve tumors was roughly one in 4000 cardiac operations There were 5 male and 5 female patients aged 2 to 66 years (mean age,30 years) The clinical presentations included exertional dyspnea in 7 patients,neurological symptoms in 2,and cyanosis at rest in 1 patient The diagnosis was established by preoperative echocardiography in 8 patients,and in the other 2,it was confirmed by the findings at operation All of the tumors were resected Eight of the ten tumors were benign,and two were malignant All patients survived the operation and recovered eventfully Late outcomes were known for all patients There were three late deaths One patient with a benign tricuspid valve died 2 months postoperatively of an electrolyte disorder The other 2 patients with a malignant mitral valve tumor died within 1 year postoperatively The 7 survivors,all with a benign valve tumor,were followed up for an average of 5 7 years (range,8 months to 19 years),and all were in functional Class Ⅰ Exercise tolerance improved to normal levels The latest follow up echocardiography showed no evidences of the local recurrence in any patients Conclusion Excellent early and late surgical results can be obtained in patients with benign valve tumors The prognosis for the patients with a malignant valve tumor is poor

关 键 词：原发性心脏瓣膜肿瘤 临床分析 心脏外科手术 治疗 

分 类 号：R732.1[医药卫生—肿瘤]