【摘要】 目的探讨巨大左房顶部黏液瘤的手术治疗难点。方法 2010年1~10月,对3例巨大左房顶部黏液瘤(7cm×4 cm×3 cm,8 cm×5 cm×4 cm,9 cm×6 cm×5 cm)行手术切除,男1例,女2例,年龄48、58、73岁,心功能Ⅱ级1例、Ⅳ级2例。采用房间隔入路手术,探查瘤体巨大,远超正常心房径线,几近充满患者扩大的左房,显露、切除操作困难。片除蒂部心内膜和内膜下心肌,以自体心包补片加固蒂部薄弱房顶组织、修补房间隔缺损。结果术中无左房顶部出血发生。1例因伤口部分愈合不良,行局部清创缝合,余无手术并发症,均康复出院。术后随访3、6、12个月,心功能均为Ⅱ级,超声心动检查无肿瘤复发,肺动脉高压和三尖瓣返流消失。结论切除巨大左房顶部黏液瘤时,术中显露很困难,可先行部分切除,良好显露后完整切除肿瘤。预防心房穿破出血是手术关键,自体心包修补房顶组织是良好处理方法。更多还原

【Abstract】 Objective To summarize the intraoperative risks and management of giant left atrial roof myxoma. MethodsFrom January to October 2010,3 cases of giant left atrial roof myxoma(7 cm×4 cm×3 cm,8 cm×5 cm×4 cm,and 9 cm×6 cm×5 cm respectively) underwent resection of the tumor through the atrium-transseptal approach(1 male and 2 female,aged 48,58 and 73 years respectively).The cardiac function of the patient was grade Ⅱ in one and grade Ⅳ in two.We found that it was difficult to expose and resect the myxoma for the left atrial cavity had been filled with the neoplasm,and thus the wide attachment of the left atrial roof was excised together with the endocardium and underlying muscles.Afterwards,autologous pericardium patch was used to strengthen the roof and repair the surgically created atrial septal defect. Results All the procedures were finished safely without hemorrhage from the left atrium roof.One patient underwent debridement for non-healing incision,and then was cured and discharged from hospital without complications.The patients were followed up at 3,6,and 12 months after the operation,during which all the patients showed grade Ⅱ cardiac function;echocardiography showed no recurrent tumors nor pulmonary hypertension or tricuspid regurgitation. Conclusions It is difficult to expose giant left atrial roof myxoma for resection.Neoplasm can be completely removed after partial excision for good exposure.Preventing intraoperative bleeding is critical for the procedure,and repairing left atrial roof with autologous pericardium patch is safe and effective to strengthen the atrial wall.更多还原