右房黏液瘤的外科治疗体会及近中期临床疗效观察

刘言一; 李鑫; 葛圣林

doi:10.16766/j.cnki.issn.1674-4152.002131

右房黏液瘤的外科治疗体会及近中期临床疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002131

安徽医科大学第一附属医院心脏大血管外科，安徽合肥 230022

基金项目:

安徽省自然科学基金项目 1808085MH279

详细信息

通讯作者:
葛圣林, E-mail：aydgsl@sina.com

中图分类号: R654.2 R732.1
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出版历程
- 收稿日期: 2020-10-14
- 网络出版日期: 2022-02-15

Surgical experience and clinical effect observation of the resection of right atrial myxomas

Department of Cardiac Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的探讨右房黏液瘤患者的临床特点及预后，总结外科治疗经验。方法自2008年1月—2018年12月共12例右房黏液瘤患者于安徽医科大学第一附属医院行浅低温体外循环下右房黏液瘤切除术，男性6例，女性6例，年龄为18~75(54.17±16.75)岁。其中正中开胸心脏停跳下手术11例，达芬奇机器人辅助心脏不停跳手术1例。回顾性分析其临床资料，总结右房黏液瘤在全部心脏黏液瘤中的比率、术前临床特征、手术技巧、瘤蒂附着部位、术后近中期疗效。结果右房黏液瘤占全部心脏黏液瘤的10.53%，瘤蒂最常见的附着部位是房间隔；全组12例手术均成功完成，手术时间为130~255(180.25±40.53)min，体外循环时间为30~72(49.17±14.33)min，中位升主动脉阻断时间为20.00(18.00~42.00)min，无围术期死亡，围术期全组患者均未出现低心排综合征、呼吸功能不全、急性肾功能不全、脑血管意外、恶性心律失常、肺栓塞等严重并发症。对9例(75.00%)患者随访12~109(44.56±30.59)个月，无死亡病例及肿瘤复发，心功能均恢复至Ⅰ~Ⅱ级(NYHA分级)。结论右房黏液瘤临床少见，一经确诊即应尽早手术，手术成功的关键在于体外循环的顺利建立以及彻底的心腔探查，外科治疗近中期疗效满意，远期预后有待进一步随访。
- 右房黏液瘤 /
- 手术切除 /
- 体外循环 /
- 心脏肿瘤
Abstract: Objective To investigate the clinical features and prognosis of right atrial myxomas and summarise the experience of surgical treatment. Methods From January 2008 to December 2018, 12 cases (6 males and 6 females) of right atrial myxomas underwent surgical resection under mild hypothermic cardiopulmonary bypass (CPB). The mean age was 18.00-75.00 (54.17±16.75) years. Amongst them, surgical resection was performed on arrested heart through median sternotomy in 11 cases, and robot-assisted surgery was performed on a beating heart in 1 case. Through retrospective analysis of the clinical data, the clinical characteristics, incidence, intraoperative technique, attachment site and short-term and middle-term surgical outcomes of right atrial myxomas were summarised. Results Right atrial myxomas comprised only 10.53% of all sporadic myxomas. The most common attachment site of right atrial myxomas was the atrial septum. All operations were successfully performed with no operative death or fatal postoperative complications such as low cardiac output syndrome, acute respiratory insufficiency, acute renal failure, stroke, malignant arrhythmia and pulmonary embolism. The operative time was 130-255 (180.25±40.53) min. The CPB time was 30-72 (49.17±14.33) min. The median aortic cross-clamping time was 20.00(18.00-42.00)min(range, 15-49 min). Nine patients (75.00%) were followed up for 12-109 (44.56±30.59) months. No deaths or recurrence occurred. The cardiac functions of all patients in the follow-up were class Ⅰ- Ⅱ (NYHA). Conclusion Right atrial myxoma is clinically rare. Once diagnosed, operation should be the first choice of treatment. The key to the success of the operation is the establishment of CPB and careful explorations to the cardiac chambers. The short-term and middle-term outcomes of surgical resection were satisfactory. However, long-term outcomes also need to be further observed.
- Right atrial myxoma /
- Surgical resection /
- Cardiopulmonary bypass /
- Cardiac tumours

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图 1 术中及术前超声情况

注：A为术中直视下纵行切开右心房，瘤体显露满意且占据右房；B、C为术前超声“心尖四腔心切面”提示瘤体位于右房，呈中等强度回声光团，舒张期部分脱入三尖瓣瓣口，RA为右心房, RV为右心室, TV为三尖瓣，M为黏液瘤。

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图 2 手术切除的右房黏液瘤大体标本及术后病理

注：A为手术切除的右房黏液瘤大体标本；B、C为术后镜下病理提示右房黏液瘤伴纤维组织增生，玻璃样变性(HE染色，×200)。

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图 3 术后随访复查超声

注：心腔内未见黏液瘤复发。

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表 1 右房黏液瘤蒂附着部位

瘤蒂附着部位	例数	百分率(%)
房间隔	7	58.33
卵圆窝处	3	25.00
房间隔下段	3	25.00
房间隔上段	1	8.33
右房游离壁	2	16.67
冠状静脉窦	1	8.33
下腔静脉开口	2	16.67

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表 2 术中探查瘤体情况与术前超声表现对照表

检查情况	瘤体(mm)			有蒂(例)	蒂附着部位(例)
检查情况	最大	最小	平均	有蒂(例)	房间隔	右房壁	冠状静脉窦	下腔开口
术中探查	90.0×80.0	25.0×22.0	56.3×45.2	12	7	2	1	2
术前超声	77.2×64.7	19.5×16.5	50.7×36.1	12	8	2	1	1

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