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目的探讨原发性心脏恶性肿瘤的诊断、外科治疗及预后。方法和结果 1999年1月至2012年5月在第二军医大学长海医院手术治疗的原发性心脏恶性肿瘤患者共13例,占同期手术治疗的心脏肿瘤患者的9.2%(13/141)。术前均经超声心动图明确诊断。胸部正中切口12例,左前外侧切口1例。完整切除8例,部分切除1例,开胸探查并取活检4例。肿瘤起源于右心房3例,右心室3例,左心房4例,左心室1例,同时累及右心房、右心室2例。术后病理结果:血管肉瘤3例,横纹肌肉瘤3例,间叶肉瘤3例,平滑肌肉瘤2例,未分化肉瘤1例,纤维黏液样肉瘤1例。无手术或院内死亡,术后均获得随访。术后中位生存时间17.5个月(1~76个月),肿瘤完整或大部分切除的患者术后中位生存时间18.5个月,仅取活检的患者术后中位生存时间8个月。结论原发性心脏恶性肿瘤多发于右心系统,心脏超声是最重要的诊断工具;心脏恶性肿瘤预后很差,手术切除是治疗心脏恶性肿瘤、改善预后的良好方法。
Objective To investigate the diagnosis, surgical treatment and prognosis of primary cardiac malignancies. Methods and Results Thirteen patients with primary cardiac malignancies underwent surgery at Changhai Hospital, Second Military Medical University between January 1999 and May 2012, accounting for 9.2% (13/141) of the patients undergoing cardiac surgery in the same period. Preoperative echocardiography were diagnosed. There were 12 cases of middle chest incision and 1 case of left anterolateral incision. Complete resection in 8 cases, partial resection in 1 case, open chest exploration and biopsy in 4 cases. Tumor originated in 3 cases of right atrium, 3 cases of right ventricle, 4 cases of left atrium, 1 case of left ventricle, involving right atrium and right ventricle in 2 cases. Postoperative pathological findings: 3 cases of angiosarcoma, 3 cases of rhabdomyosarcoma, 3 cases of mesioblastoma, 2 cases of leiomyosarcoma, 1 case of undifferentiated sarcoma, and 1 case of fibromyxoid sarcoma. No surgery or hospital deaths were obtained after follow-up. The median postoperative survival time was 17.5 months (range 1 to 76 months). The median survival time was 18.5 months in patients with complete or major tumor resection, and the median survival time in patients who underwent biopsy alone was 8 months. Conclusions Primary cardiac malignancies are often found in the right ventricular system. Echocardiography is the most important diagnostic tool. The prognosis of cardiac malignant tumors is very poor. Surgical resection is a good method to treat cardiac malignant tumors and improve prognosis.