53例小儿心脏肿瘤临床病例分析

发布时间：2018-02-27 16:23

本文关键词： 心脏肿瘤诊断治疗预后儿童　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的总结与分析心脏肿瘤(CTs)患儿的临床资料,为该病诊治提供指导依据。方法收集1981年01月~2016年12月我院诊治的53例CTs患儿的资料,归纳总结CTs的类型、生长特点和临床表现,评价超声心动图(UCG)及磁共振显像(MRI)的诊断价值;并根据治疗方式将患儿分为手术治疗组、非手术治疗组和观察组,随访2月~8年2月,分析各组患儿的预后。结果1.53例CTs中良性肿瘤45例(84.9%),包括横纹肌瘤23例(43.4%),粘液瘤15例(28.3%),纤维瘤3例(5.7%),脂肪瘤、血管瘤、畸胎瘤、囊肿各1例(1.9%);恶性肿瘤8例(15.1%),包括转移性心脏肿瘤(MCTs)7例(13.2%)、原发性心脏肿瘤(PCTs)1例(1.9%)。2.CTs的位置以多房室(16/53例,30.2%)最常见,单发为主(33/53例,62.3%)。横纹肌瘤均位于心室壁和(或)室间隔,常多发(17/23例,73.9%);粘液瘤多带蒂(14/15例,93.3%),好发于心房(9/15例,60.0%);MCTs多位于右心房(6/7例,85.7%)。3.初诊时无任何表现者8/53例(15.1%),存在心血管系统表现27/53例(50.9%)且以心脏杂音(20/27例,74.1%)最多,呼吸、神经系统表现各15/53例(28.3%)。胸片、心电图均无特异性。4.52/53例(98.1%)行UCG检查,其中36/52例(69.2%)明确CTs类型,7/52例(13.5%)诊断MCTs,9/52例(17.3%)诊断心脏占位性病变。13/53例(24.5%)行MRI检查,均明确肿瘤性质,其中9/13例(69.2%)确定CTs类型,1/13例(7.7%)囊肿误诊为粘液瘤。5.手术治疗组16/53例(30.2%),远期随访死亡1/16例(6.3%),完全切除(13/16例,81.3%)或部分切除(3/16例,18.7%)对远期预后无影响(P=1.000)。非手术治疗组17/53例(32.1%),其中放弃手术者死亡5/9例(55.6%),明显多于手术治疗组(P=0.012)。观察组20/53例(37.7%)均为横纹肌瘤,其中15例随访者均存活。结论小儿CTs大多呈良性,横纹肌瘤最常见。临床表现多样且无特异性。UCG是初步评估CTs的首选检查方法;MRI作为补充可进一步鉴别CTs性质,明确横纹肌瘤、纤维瘤等较常见的CTs类型;病理组织检查仍是诊断该病的金标准。小儿CTs的治疗应遵循个体化原则,对于肿瘤类型特殊(粘液瘤、巨大纤维瘤、畸胎瘤等)或存在血流梗阻、明显临床表现的患儿,手术切除治疗能有效缓解病情、改善预后,无手术治疗指征者应定期随访观察。
[Abstract]:Objective to summarize and analyze the clinical data of children with cardiac neoplasms (CTS) and to provide guidance for the diagnosis and treatment of the disease. Methods 53 cases of CTs were collected from January 1981 to December 2016 in our hospital, and the types, growth characteristics and clinical manifestations of CTs were summarized. To evaluate the diagnostic value of echocardiography (UCG) and magnetic resonance imaging (MRI), and to divide the children into three groups according to the treatment methods: the operative group, the non-operative group and the observation group, followed up from February to February for 8 years. Results 1.Among 53 cases of CTs, 45 cases had benign tumors (84.9%), including 23 cases of transverse leiomyoma (23 cases), 15 cases of myoma (28. 3%), 3 cases of fibroma (5. 7%), lipoma, hemangioma, teratoma. One case of cysts, one case of cysts, one case of malignant tumor, eight cases of malignant tumor, including 7 cases of metastatic cardiac tumor, 7 cases of MCTsma, 1 case of primary cardiac tumor, 1 case of primary cardiac tumor, 1 case of PCTsT, 1 case of primary cardiac tumor and 1.99%. 2. The most common location of CTs was multiple atrioventricular septum (n = 1653), with 33 / 53 cases (62.33%). All striated leiomyomas were located in the ventricular wall and (or) ventricular septum, and most of them were located in the ventricular wall and (or) ventricular septum. There were 17 / 23 cases of myxoma with multiple pedicles, 15 cases with myxoma with multiple pedicle and 93% with myxoma, which occurred in 915% of the atrium in 60.015 cases. The MCTs were mostly located in the right atrium in 67 / 7 cases with 85.77.3.There were 8/53 cases with no manifestation at first visit, 27/53 cases with cardiovascular system and 50.9%), and the heart murmur was 20-27 cases with 74.1%. There were 15/53 cases of neurologic manifestations and 28.3% of the chest radiographs, none of which were specific. 4.52% of 53 cases (98.1%) were examined by UCG, of which 36/52 cases (69.2%) confirmed the type of CTs: 752 cases (13.5%).) 9 / 52 cases (17.3%) were diagnosed as cardiac occupying lesions. (13% 53 cases (24.5B) were examined with MRI, all of which were clear about the nature of the tumor. Among them, 9/13 cases (69.2%) were misdiagnosed as myxoma, 16/53 cases in the surgical treatment group, 1/16 cases died in long-term follow-up, 16 cases with complete resection of 13 / 13% (81.3%) or 18.7% with partial resection) had no effect on the long-term prognosis. 17/53 cases in the non-operative group had no effect on the long-term prognosis. Among them, 5/9 patients died of giving up the operation (55.6%), which was obviously more than that of the surgical treatment group (0.012%) and the observation group (20/53 cases (37.7%)) were all transverse striated leiomyomas. Conclusion most of the children with CTs are benign, and the most common of them are striated leiomyomas. The clinical manifestations are diverse and nonspecific. UCG is the first choice for the preliminary evaluation of CTs. It can be used to further differentiate the nature of CTs and determine the leiomyoma of transverse striatum. The pathological examination is still the gold standard for the diagnosis of the disease. The treatment of pediatric CTs should follow the principle of individualization, especially for the tumor type (myxoma, giant fibroma, teratoma, etc.) or the existence of blood flow obstruction. In children with obvious clinical manifestations, surgical resection can effectively alleviate the condition and improve the prognosis. The patients without indications of surgical treatment should be followed up regularly.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R732.1

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