复发性心脏粘液瘤的外科治疗：病例汇报及文献综述

发布时间：2018-07-27 09:14

【摘要】：目的总结复发性心脏粘液瘤的外科治疗和经验。方法回顾性分析浙江大学附属第一医院自2009年至2017年间共计2例复发性心脏粘液瘤患者,统计和收集英文期刊数据库(Pubmed)自2010年以来共计16例的复发性心脏粘液瘤的病例汇报,合计18例,应用SPSS作为统计软件,通过卡方检验进行数据分析。18例患者首次发病的平均年龄为36.6±13.9岁(13～60岁),其中男性患者占33.3%,女性患者占66.7%,符合文献报道的1:2比例。18例患者中有4例在首次发病时即为多发性粘液瘤,其中2例在首次复发时亦表现为多发性,另有4例首次发病时为单发性粘液瘤的患者在首次复发时表现为多发性。有明确基因突变证据的患者有3例,且3例患者均发生了多次复发。18例患者的首次复发时间平均为4.9±5.1年(0.5～21年)。将18例患者依据首次发病部位分为2组:典型位置组(粘液瘤首次发生位置位于房间隔卵圆窝附近、单蒂、局限于左心房、无基因异常证据,共6例,占33.3%)和非典型位置组(粘液瘤首次发生位置位于除左房房间隔外其他部位,共12例,占66.7%)。比较2组患者的多次复发率,并结合相关文献进行归纳分析。结果共计6例患者出现了多次复发,其中3例有明确的基因突变证据,5例首次发病时肿瘤发生于非典型位置,1例在首次发病时即为多发性粘液瘤。结论心脏粘液瘤作为良性肿瘤亦可危及患者生命,一经确诊应尽早手术切除。超声心动图是首选用于心脏粘液瘤筛查的辅助检查。对于肿瘤生长位置不典型或多发性心脏粘液瘤或家族性粘液瘤或Carney综合征的患者,复发及多次复发的风险较高,建议应常规进行基因检测,并建议患者及其1级亲属均定期复查心超,以免延误治疗。
[Abstract]:Objective to summarize the surgical treatment and experience of recurrent cardiac myxoma. Methods two patients with recurrent cardiac myxoma from 2009 to 2017 in the first affiliated Hospital of Zhejiang University were retrospectively analyzed. 16 cases of recurrent cardiac myxoma from 2010 to 2010 were collected and collected from (Pubmed), an English journal database. Total 18 cases, using SPSS as statistical software, The average age of first onset in 18 patients was 36.6 卤13.9 years old (1360 years old) by chi-square test. Among them, 33.3% were male and 66.7% were female. Is called multiple myxoma, Among them, 2 cases showed multiple at the first recurrence, and 4 cases showed multiple at the first time of recurrence in the patients with single myxoma at the first time of onset. There were 3 patients with definite gene mutation evidence, and the first recurrence time of 18 patients was 4.9 卤5.1 years (0.5 ~ 21 years). The 18 patients were divided into two groups according to the site of the first onset: the typical location group (the first occurrence of myxoma was located near the septal fossa ovale, single pedicle, confined to the left atrium, no evidence of gene abnormality, 6 cases). There were 12 cases (66.7%) in the group of atypical location (12 cases (66.7%) were located in the first location of myxoma except the left atrial septum). To compare the multiple recurrence rate of the two groups, and combined with the relevant literature to sum up and analyze. Results A total of 6 patients had multiple recurrence, of which 3 had clear evidence of gene mutation. 5 cases had tumor in atypical location at the first time of onset. 1 case was multiple myxoma at the first time of onset. Conclusion Cardiac myxoma, as a benign tumor, may endanger the life of the patient and should be resected as soon as possible. Echocardiography is the first choice for cardiac myxoma screening. For patients with atypical or multiple cardiac myxoma or familial myxoma or Carney syndrome, the risk of recurrence and multiple recurrence is higher. It is suggested that patients and their first degree relatives should be reexamined regularly to avoid delay in treatment.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R732.1

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