临床荟萃 ›› 2020, Vol. 35 ›› Issue (11): 980-983.doi: 10.3969/j.issn.1004-583X.2020.11.004

• 论著 • 上一篇    下一篇

心房黏液瘤合并冠心病的诊断与外科治疗

  

  1. 河北医科大学第二医院 心脏外科,  河北 石家庄 050000
  • 出版日期:2020-11-20 发布日期:2020-10-21
  • 通讯作者: 石凤梧, Email: shifengwu65@163.com

Diagnosis and surgical treatment of atrial myxoma combined with coronary heart disease

  1. Department of Cardiac Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Online:2020-11-20 Published:2020-10-21
  • Contact: Corresponding author: Shi Fengwu, Email: shifengwu65@163.com

摘要: 目的  总结心房黏液瘤摘除同期行冠状动脉搭桥的临床治疗经验。方法  回顾性分析我科2013年1月至2019年3月18例同期行心房黏液瘤摘除+冠状动脉搭桥术患者的临床资料、手术方法及预后情况。结果  所有患者均在体外循环下行房黏液瘤摘除+冠状动脉搭桥术,根据手术所见,肿瘤位置与心脏超声所见位置一致。术中所见肿瘤大小不一,形态呈分叶状、不规则形、类圆形等,质脆,多数为胶冻样,少数有完整包膜,表面可有黏液渗出或出血,少数表面出现钙化。部分肿瘤瘤体可坠入二尖瓣口或三尖瓣口。术后无死亡病例。术后低心排综合征1例,经相应的治疗而治愈;术后新发心房颤动5例,均经用胺碘酮后转复正常;二次开胸止血2例。术后随访1年,18例患者均未见瘤体复发,心功能恢复到 NYHAⅠ~Ⅱ级。结论  心房黏液瘤摘除同期行冠状动脉搭桥是治疗心房黏液瘤合并冠心病的有效方法,可取得良好的预后效果。

关键词: 黏液瘤, 冠状动脉分流术, 外科手术

Abstract: Objective  To summarize the clinical experience of simultaneous coronary artery bypass grafting (CABG) and atrial myxoma removal. Methods  Clinical data, surgical methods and prognosis of 18 patients undergoing atrial myxoma removal and CABG in our department from January 2013 to March 2019 were retrospectively analyzed. Results  All patients underwent simultaneous CABG and atrial myxoma removal  under extracorporeal circulation. According to the tumors seen during the operation, the tumor locations were consistent with those observed by cardiac ultrasound. And the tumors were different in sizes and shapes, such as lobulated, irregular and close round appearance. The tumors were brittle, most of them were gelatinous and few possessed envelope with mucus effusion, bleeding or calcification on the surface.  A few parts of tumors can fall mitral or tricuspid valve mouth.  There were no postoperative deaths. One case with postoperative low cardiac output syndrome was cured after corresponding treatment. There were 5 patients with newly atrial fibrillation after operation, and all of them returned to normal after treatment with amiodarone. Two patients underwent  rethoracotomy for hemostasis. After the postoperative followup of one year, no tumor recurrence was found in 18 patients, and their cardiac function returned to NYHA ⅠⅡ. Conclusion  The simultaneous removal of atrial myxoma and CABG are effective methods for treating atrial myxoma complicated with coronary heart disease, which can achieve a good prognosis.

Key words: myxoma, coronary artery bypass grafting, surgical procedure, , operative

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