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原發性心臟腫瘤的外科治療

目的 總結原發性心臟腫瘤的外科治療經驗，以提高手術療效。 方法 回顧性分析1980年6月至2008年12月中國醫科大學附屬第一醫院收治的263例原發性心臟腫瘤患者的臨床資料，其中男90例，女173例；年齡10～79歲（41±13歲）。良性腫瘤241例，其中良性粘液瘤240例，纖維瘤1例；惡性腫瘤22例，其中惡性粘液瘤7例，惡性間皮瘤4例，血管肉瘤5例，橫紋肌肉瘤1例，肺動脈內膜肉瘤1例，平滑肌肉瘤1例，炎癥性惡性纖維組織細胞瘤1例，惡性淋巴瘤1例，滑膜肉瘤1例。手術完整摘除腫瘤252例（惡性腫瘤11例），局部切除腫瘤5例（均為惡性腫瘤），開胸探查取病理活組織檢查6例（均為惡性腫瘤）。同期行冠狀動脈旁路移植術（CABG）5例，二尖瓣置換術5例，二尖瓣成形術4例，三尖瓣成形術9例，三尖瓣生物瓣置換術1例，主動脈根部及肺動脈成形術1例，肺動脈瓣置換術1例，肺動脈主干及左右肺動脈人工血管加肺動脈瓣置換術1例，肺動脈切開取栓術1例，經股動脈取瘤栓術5例。 結果 圍術期死亡7例（良性粘液瘤6例、惡性粘液瘤1例），其中術中不能停體外循環2例，術后發生低心排血量、心室顫動3例，呼吸、循環衰竭1例，大面積腦出血1例；其余患者無并發癥發生。隨訪247例（良性腫瘤229例，惡性腫瘤18例），隨訪時間3個月～28年，失訪9例（良性腫瘤6例、惡性腫瘤3例）。隨訪期間良性粘液瘤復發4例，均再次手術治療；良性腫瘤患者死亡13例（心源性猝死6例、腦卒中2例、肺癌1例、不明原因4例），其余216例均生存。隨訪期間惡性腫瘤患者死亡15例，術后生存時間為1～4年，死于腫瘤復發或轉移11例，心力衰竭和惡病質各2例。 結論 原發性心臟腫瘤一經確診應盡早手術治療，良性腫瘤手術效果好，惡性腫瘤術中應盡量切除腫瘤。

101例心臟粘液瘤的外科治療體會

目的總結101例心臟粘液瘤的診斷和治療經驗，以提高療效。方法回順性分析101例心臟粘液瘤患者的臨床資料，其中左心房粘液瘤94例，右心房粘液瘤6例，雙心房粘液瘤1例，均在體外循環下行粘液瘤摘除術；同期行二尖瓣成形術5例，二尖瓣機械瓣置換術1例，三尖瓣成形術32例，冠狀動脈旁路移植術1例，激光心肌打孔血運重建術1例。結果術后死亡1例，100例患者經治療痊愈出院。隨訪84例，隨訪率84％（84／100）；隨訪時間3個月～5年，復發1例。結論心臟粘液瘤術前超聲心動圖檢查診斷準確率高，一經確診應盡早手術；手術的關鍵是保持瘤體完整，將瘤體連同蒂部周圍部分組織一并切除。

Diagnosis and Surgical Treatment of 103 Patients with Cardiac Tumors

Objective To explore the diagnosis accuracy of cardiac tumor and effectiveness of surgical treatment. Method We retrospectively analyzed the clinical data of 103 patients with cardiac tumor in our hospital from 2011 through 2014 year. There were 65 females and 38 males, aging from 3 months to 82 years (average age of 59.71±13.80 years). We analyzed age distribution and clinical manifestation of the patients, as well as size and location of tumors. Then we compared effects of different surgical procedures. Result There was no death during evaluation. Early postoperative complications included arrhythmia (47 patients), electrolyte disturbance (13 patients), and cardiac dysfunction (9 patients). One patient with B-cell non-Hodgkin's lymphoma auto-discharged because of cardiac dysfunction. No relapse was obse-rved in the patients with atrial myxoma or lipoma (2 patients) during follow-up. One patient with benign myogenic tumor was lost during the follow-up. Six patients with malignant tumor were with poor long-term effect including 2 patients lost in the follow-up and 4 deaths due to tumor relapse during 1 year after surgery. Conclusion Surgery is still the most effective and major therapy of cardiac tumor.

Clinical characteristics and postoperative recurrence factors of 1 106 patients with cardiac myxoma

Objective To summarize the clinical characteristics and surgical treatment experience of 1 106 patients with cardiac myxoma. Methods Clinical data of 1 106 patients with cardiac myxoma who underwent surgical treatment in Beijing Anzhen Hospital from 2002 to 2018 were retrospectively analyzed. There were 749 (67.7%) females and 357 (32.3%) males. Results The highest incidence rate was at the age of 51-70 years. The location of the disease was: left atrium in 987 (89.2%) patients, right atrium in 99 (9.0%) patients, left ventricle in 10 (0.9%) patients, right ventricle in 8 (0.7%) patients. There were 1 013 patients of heart classification (NYHA) Ⅰ-Ⅱ and 93 patients of Ⅲ-Ⅳ. There were 301 patients with cerebral infarction and 57 patients with peripheral arterial embolism. Tumor size was closely related to hemodynamic symptoms (P≤0.05), but not to peripheral vascular embolism (P>0.05). Two (0.2%) patients died in hospital and 306 patients were followed up, with a follow-up rate of 27.7%. The median follow-up time was 7 years (range, 1-18 years). One patient died of all causes, and 23 patients recurred, with a recurrence rate of 2.1%. Among 23 recurrent patients, 15 (65.2%) patients were atypical myxoma and 8 (34.8%) patients were typical myxoma. There was no statistical difference in aortic clamping time, ICU stay time, ventilator-assisted breathing time, postoperative hospital stay time, postoperative mortality, or cardiac ejection fraction at discharge between the reoperation in 23 recurrent patients and the first operation in 1 083 non-recurrentpatients. Conclusion Cardiac myxoma is more common in middle-aged and elderly women, and it often occurs in the left atrium. The size of cardiac myxoma can affect the hemodynamic changes. Surgical treatment is effective. Atypical myxoma is more common in recurrent patients, and the effect is still satisfactory through surgical treatment.

右心室粘液瘤一例

右心房粘液瘤累及三尖瓣一例

Clinical efficacy of endoscopic minimally invasive versus median sternotomy thoracotomy for atrial myxoma: A systematic review and meta-analysis

ObjectiveTo compare the clinical efficacy of endoscopic minimally invasive surgery and median sternotomy thoracotomy in the treatment of atrial myxoma by meta-analysis.MethodsWe searched CBM, CNKI, Wanfang Data, VIP, PubMed, the Cochrane Library and EMbase to collect relevant researches on atrial myxoma and endoscopic minimally invasive surgery. The retrieval time was from the establishment of the database to September 2020. Two reviewers independently screened the literature, extracted data and evaluated the bias risk of included studies by the Newcastle-Ottawa scale (NOS). Then, the meta-analysis was performed by Stata 16.0.ResultsTen articles were included in the study, all of which were case-control studies. The quality of literature was grade B in 5 articles and grade A in 5 articles. The sample size of surgery was 938 patients, including 480 patients in the endoscopic minimally invasive group, 458 patients in the median thoracotomy group, and 595 patients in follow-up. A total of 18 outcome indexes were included in the meta-analysis. The combined results of 9 outcome indicators were statistically significant: cardiopulmonary bypass time (SMD=0.32, 95%CI 0.00 to 0.63, P=0.048); ventilator assisted ventilation time (SMD=?0.35, 95%CI ?0.56 to ?0.15, P=0.001), ICU stay time (SMD=–0.42, 95%CI ?0.62 to ?0.21, P<0.001); postoperative hospitalization time (SMD=?0.91, 95%CI ?1.22 to ?0.60, P<0.001); postoperative drainage volume (SMD=?2.48, 95%CI ?5.24 to 0.28, P<0.001); postoperative new onset atrial fibrillation (OR=0.29, 95%CI 0.12 to 0.67, P= 0.005); postoperative pneumonia (OR=0.09, 95%CI 0.02 to 0.36, P=0.001); postoperative blood transfusion (OR=0.22, 95%CI 0.11 to 0.45, P<0.001); incision satisfaction (OR=83.15, 95%CI 1.24 to 5563.29, P=0.039).ConclusionAvailable evidence suggests that median thoracotomy requires shorter cardiopulmonary bypass time than endoscopic minimally invasive surgery; during the 5-year follow-up after surgery and discharge, ICU stay time, postoperative hospital stay, postoperative drainage, new atrial fibrillation after surgery, postoperative pneumonia, postoperative blood transfusion, satisfactory incision, endoscopic minimally invasive surgery showed better results than median sternotomy thoracotomy.

心房粘液瘤36例臨床分析

目的總結心房粘液瘤的臨床特點、手術效果和治療難點。 方法回顧性分析2001年5月至2011年11月昆明醫科大學第二附屬醫院收治的36例心房粘液瘤患者的臨床資料。其中男9例、女27例，年齡26～57（43.0±7.6）歲，病程1～18個月。左心房粘液瘤33例，右心房粘液瘤2例，雙心房粘液瘤1例。 結果術前巨大左心房粘液瘤死亡1例，體外循環下手術治療35例，無手術死亡病例，無術后相關并發癥，隨訪4個月至7年，無術后復發病例。 結論心房粘液瘤病情進展迅速，診斷明確后應積極手術治療。對瘤體大、位置特殊的病例，操作尤須仔細、規范，以減少術后并發癥的發生和復發。

起源于二尖瓣瓣環的心臟粘液瘤一例

Clinical Outcomes of Left Atrial Myxoma Resection via Right Anterolateral Minithoracotomy

ObjectiveTo investigate clinical outcomes and safety of minimally invasive left atrial myxoma (LAM) resection via right anterolateral minithoracotomy (ALMT). MethodsClinical data of 9 patients who underwent minimally invasive LAM resection via right ALMT in the Affiliated Hospital of Luzhou Medical College from January 2011 to October 2013 were retrospectively analyzed. There were 2 male and 7 female patients with their age of 37-62 (51±9) years. The operation was performed through a small (4-6 cm) right ALMT incision. Femoral artery and vein and superior vein were cannulated to establish cardiopulmonary bypass (CPB). Transthoracic clamp was used for ascending aortic clamping. Antegrade cold blood cardioplegia was infused for myocardial protection. LAM was resected through right atriotomy trans-septal approach. ResultsAll the operations were successfully performed without in-hospital death. Operation time was 210-310(260±33) minutes, aortic cross-clamping time was 23-50(37±9) minutes, CPB time was 60-87(71±9) minutes, postoperative mechanical ventilation time was 6-14(9.0±2.5) hours, and length of ICU stay was 17-26(20±3) hours. Postoperative mediastinum drainage was 100-650(376±190) ml. Mean length of right ALMT was 4.5-6.0 (5.3±0.6) cm. All the patients were followed up for 1 to 30 months,and echocardiography showed no LAM recurrence. ConclusionMinimally invasive LAM resection via right ALMT is safe and feasible with satisfactory clinical outcomes.