【作者】 李杰；

【导师】 张新；

【作者基本信息】 郑州大学 ， 外科学（心血管外科）（专业学位）， 2016， 硕士

【摘要】 研究背景和目的随着医学诊疗技术的的不断发展以及人民生活水平的持续提高,健康人群例行体检以及非心脏疾病患者接受心血管方面的检查的人群越来越多。因此,心脏肿瘤近年来的查出率相比以前也有比较明显的提高。从1896年,德维希雷恩为一例心脏外伤的病人进行缝合至今,心脏外科经历了一百多年的发展,心脏外科各类疾病的诊断和手术治疗都得到了显著的提高。国内外许多学者也对心脏肿瘤进行了比较深入的研究,主要集中在对肿瘤病理特点和外科手术治疗的研究分析,而对其年龄分布特点、肿瘤大小、肿瘤分布部位等研究尚欠缺。另外,心脏肿瘤的临床表现变异性比较大,诊断比较困难,给临床医生的诊断带来挑战,临床上误诊的情况也时有发生,肿瘤分布部位的特殊性又给手术治疗带来很多挑战。近年来,我中心遇到好几例此类情况。本研究的目的是对近5年来在郑州大学第一附属医院心血管外科接受外科手术治疗的心脏肿瘤患者的临床病例资料进行研究分析,总结规律以及临床经验和教训,了解心脏肿瘤的临床病理特点及外科手术治疗效果以及远期预后情况。方法本研究采用回顾性分析的研究方法,利用我院的信息管理系统优势,通过临床病历管理系统对2011年1月至2015年12月在郑州大学第一附属医院心外科接受心脏外科手术治疗的约10000例患者的病历资料进行筛选,通过整理分析,选取在我中心接受外科手术治疗的165例心脏肿瘤患者作为研究对象,其中男性患者55例(33.33%),女性110例(66.67%),男：女为1：2,年龄为3月-82岁,平均(50.01±14.89)岁,对其一般资料、临床特点、病理类型、手术方式及术后效果和远期预后等进行研究分析。结果165例心脏肿瘤患者中,有156例为良性肿瘤,9例为恶性心脏肿瘤。良性肿瘤中,粘液瘤有146例,其中包括左心房粘液瘤120例,右心房粘液瘤24例,右心室粘液瘤2例,脂肪瘤3例,1例血管瘤位于心包,1例嗜铬细胞瘤位于右心房,1例子宫内膜异位位于右心室,2例平滑肌瘤均位于右心房,1例畸胎瘤位于心包,1例胸腺瘤位于心包。9例恶性肿瘤中,1例腺癌,位于右心室,2例鳞癌均为心包占位,3例淋巴瘤,均在右心房,2例滑膜肉瘤,都是心包占位,另外1例横纹肌肉瘤的肿瘤部位在右心房和肺动脉。围术期有2例患者死亡,死亡率1.21%。1例为右心房粘液瘤合并缩窄性心包炎,三尖瓣关闭不全的63岁男性患者,另外1例是术后病理诊断为右心房B细胞性非何奇金淋巴瘤的59岁女性患者。其余163例患者均痊愈出院。125例患者获得随访,随访率为76.69%,随访期内粘液瘤复发2例,复发率为(2/145,1.38%),复发时间分别为术后3月和术后2年。随访期间内死亡患者5例,1例主要因脑梗塞死亡,3例为恶性肿瘤复发,1例的具体死亡原因不详。随访期间死亡率为4.00%,因恶性肿瘤复发死亡率为2.40%,占恶性肿瘤患者的42.86%(3/7)。良性肿瘤的患者中没有因为肿瘤复发引起患者死亡的情况发生。结论外科手术切除的治疗策略目前仍然是心脏肿瘤患者治疗的首选方法。粘液瘤患者的手术治疗效果比较理想,死亡率以及远期的复发率是比较低的,其他良性心脏肿瘤的也得到了比较满意的效果,而恶性心脏肿瘤的临床预后较差。然而,对于心脏肿瘤患者来说,及早的诊断以及外科手术治疗对患者的生存率可能有一定的提高。更多还原

【Abstract】 Research Background and Objective:With the continuous development of medical technology and living standard, much more people have accepted cardiovascular examination, including patients with no heart disease. Therefore, the detection rate of cardiac tumors is higher than before. Cardiac surgery has experienced more than one hundred years since DR. Ludwig Rehnfirst performed suture on a patient with cardiac wound in 1896. Diagnosis and surgical treatment of cardiac surgery of all sorts of diseases have also been significantly improved since then. Many scholars have accomplished some researches on, which were mainly concentrated on the analysis of pathological characteristics and surgical treatment ofcardiac tumors, yet theabout age distribution, tumor size, tumor location is still lacking. In addition, the clinical manifestations and location of cardiac tumors is variable,bringing some challenges to surgeries. In recent years, our center met several such cases This study aims to analyze the clinical data of patients with cardiac tumors in recent 5 years underwent surgical treatment in our center, to figure out the clinical features and surgical treatment of cardiac tumors.Methods:A retrospective study of 165 patients diagnosed with cardiac tumor, selecting from almost 10,000 patients in our cardiac center, was performed from January 2011 to December 2015. The clinical dates were collected and analyzed. There are 110 females (66.67%) and 55 males (33.33%), aging from 3 months to 82 years (50.01 ± 14.89). The ratio of female to male is 2:1. The general data, clinical features, pathological type, operation mode and long-term prognosis were researched and analyzed.Results:There were 156 cases of benign tumor and 9 of malignant inl65 cases.There were 146 cases of myoma, including 120 cases of left atrial myxoma and 24 of right atrial myxoma and 2 of right ventricular myxoma,3of lipoma,1 of hemangioma located in the pericardial,1 of pheochromocytoma in the right atrium,1 of ectopic endometrium in right ventricle,2 of eosinophilic leiomyoma in the right atrium,1 of teratoma in the pericardial.1 cases of thymoma in the pericardial. Among the 9 cases of malignant tumor,1 of adenocarcinoma was located in the right ventricle,2 of squamous cell carcinoma were pericardial space occupying,3 of lymphoma were located in right atrium,2 of synovial sarcoma were pericardial space occupying,1 of rhabdomyosarcoma was in the right atrium pulmonary arteries. The perioperative mortality rate was 2(1.21%).The remaining 163 patients were cured. 125 cases of patients were followed up(76.69%).2 cases of myxoma recurrent during the follow-up period (3 months and 2 years after surgery), the recurrence rate was 1.38%. During the follow-up period,5 cases died,1 case died of cerebral infarction,3 cases died of recurrence of malignant tumor,1 case died of other cause. During the follow-up period, the mortality rate was 4.00%, the recurrence of the malignant tumor mortality rate was 2.40%, accounting for 42.86% of the patients with malignant tumor (3/7). No death occurred due to tumor recurrence in patients with benign tumor.Conclusion:Surgical resection is still the best method for treatment of cardiac tumors. The outcome of surgical treatment for myxoma is the best among all cases,the mortality and recurrence rate was low. The outcome of other benign cardiac tumors is also quite satisfactory. Butthe outcome of surgical treatment of malignant cardiac tumors is the worst. Early diagnosis and surgical treatment are keys to improve the survival rate of patients with cardiac tumors.更多还原