摘要
目的探讨小儿原发性心脏肿瘤的病理特征和治疗经验。方法回顾性分析2004年1月至2017年12月上海儿童医学中心135例心脏肿瘤患儿的临床资料。诊断年龄中位数0.54岁(0~14.36岁),肿瘤呈单发性61例,多发性74例。45例有明显临床症状或血流梗阻,4例有轻度血流梗阻,86例无症状。手术治疗41例,未行手术94例。肿瘤完全切除24例,部分切除16例,心脏移植1例,瓣膜成形13例。结果本院手术40例,术后早期循环稳定35例,发生严重低心排症状5例。其中经治疗后心功能恢复正常2例,死亡3例(住院死亡率7.5%)。另1例外院行心脏移植术后存活,随访24个月心功能良好。良性肿瘤部分切除与完全切除术后生存率比较差异无统计学意义;恶性肿瘤术后2年死亡1例。94例未手术患儿中,放弃手术死亡1例,等待心脏移植手术死亡1例,尚在等待心脏移植2例,其余90例无血流动力学紊乱症状。结论小儿原发性心脏肿瘤多为良性肿瘤,可以长期随访。对有明显血流梗阻、心律失常及恶性心脏肿瘤患儿,手术治疗是必需的。手术原则不强求完整切除肿瘤,可行部分切除以消除血流梗阻症状。对无法行手术切除的心脏肿瘤,心脏移植可能是唯一选择。
Objective To investigate the pathology characteristics,so as to provide treatment experience of primary cardiac tumors for pediatric patients.Methods A retrospective study was conducted for 135 patients with primary cardiac tumor between January 2004 and December 2017 in Shanghai Children′s Medical Center.The median age was 0.54 years(range,0-14.36 years).Single tumor was discovered in 61 cases and multiple rumors were found in 74 cases.Forty-five patients presented obvious clinical symptoms,4 patients with mild symptoms and 86 patients without symptoms.Forty-one patients underwent surgical treatment,including complete resection of the tumor in 24 cases,partial resection in 16 cases and heart transplantation in 1 case.Concomitant valvuloplasty was required in 13 patients.Ninety-four patients did not receive surgical treatment.Results A total of 40 patients underwent surgical treatment in Shanghai Children′s Medical Center.Three patients died of low cardiac output(in-hospital mortality:7.5%),and 2 patients recovered from postoperative low cardiac output.The hemodynamic status was stable in the remaining 35 cases.One patient who received heart transplantation in another hospital survived and had good cardiac function during 24 months follow-ups.There were no significant differences in the survival rate between partial resection and complete resection of benign tumors.One late death was observed in patients with malignant tumors for 2 years after operation.Surveillance was kept in 94 non-surgical patients,among whom 1 case died for the abandon of surgery and 1 case died when waiting for heart transplantation.Other 2 patients were waiting for heart transplantation and other 90 patients had no hemodynamic disorder.Conclusion Most of primary cardiac tumors are benign and long time follow-up should be able to get on for pediatric patients.When patients develop hemodynamical obstruction,arrhythmia or malignant tumor,surgical treatment is necessary.The principle of surgical therapy in these patients is to restore normal hemodynamic status,instead of completely removing tumor.Heart transplantation is potentially the only way for patients whose tumor cannot be resected.
作者
蔡及明
李杨鑫
仇黎生
刘旭
郁夏风
刘锦纷
Cai Jiming;Li Yangxin;Qiu Lisheng;Liu Xu;Yu Xiafeng;Liu Jinfen(Department of Cardiothoracic Surgery,Shanghai Children′s Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2020年第23期1790-1793,共4页
Chinese Journal of Applied Clinical Pediatrics
关键词
心脏肿瘤
原发性
手术
儿童
Cardiac tumor,primary
Surgical therapy
Child
