中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

心脏粘液瘤导致栓塞事件的临床分析

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目的 探讨心脏粘液瘤患者的临床表现及影响栓塞事件发生的因素。 方法 回顾性研究 2010 年 1 月至 2017 年 12 月期间在我院诊断并经手术切除的 38 例心脏粘液瘤患者的临床资料,将患者分为非栓塞组与栓塞组,总结患者临床表现,分析导致栓塞的因素。 结果 非栓塞组 26 例,临床症状为呼吸困难者 22 例(84.62%),心悸者 14 例(53.85%),心绞痛者 4 例(15.38%),心衰者 1 例(3.85%);栓塞组 12 例,临床症状为呼吸困难者 4 例(33.33%),心悸者 3 例(25%),心绞痛者 1 例(8.33%)。非栓塞组肿瘤最大直径平均为(5.71±1.63)cm,栓塞组肿瘤最大直径平均为(4.52±1.88)cm,栓塞组肿瘤最大直径与非栓塞组肿瘤最大直径差异无统计学意义(P>0.05)。非栓塞组 2 例术前发生房颤,栓塞组 5 例术前发生心房颤动,栓塞组更易发生房颤(P<0.05)。 结论 心脏粘液瘤患者发生房颤与栓塞事件密切相关,粘液瘤大小与栓塞事件发生无确切关系。

Objective To investigate the clinical manifestations of patients with cardiac myxoma and the factors affecting the occurrence of embolic events. Methods A retrospective study of 38 patients with cardiac myxoma diagnosed and surgically removed from January 2010 to December 2017 was performed. The patients were divided into a non-embolized group and an embolized group. The clinical manifestations of the patients were summarized and the factors leading to embolism were analyzed. Rseults Of the 26 patients in the non-embolized group, 22 patients (84.62%) had dyspnea, 14 patients (53.85%) had palpitations, 4 patients (15.38%) had angina pectoris, and 1 patient (3.85%) had heart failure. Of the 12 patients in the embolized group, 4 patients (33.33%) had dyspnea, 3 patients (25%) had palpitations, and 1 patient (8.33%) had angina pectoris. The mean diameter of the non-embolized group was (5.71±1.63) cm, and the maximum diameter of the tumor in the embolized group was 4.52±1.88 cm. There was no significant difference between the maximum diameter of the tumor in the embolized group and the maximum diameter of the non-embolized group (P> 0.05). Atrial fibrillation occurred in 2 patients in the non-embolized group before operation. Atrial fibrillation occurred in 5 patients in the embolized group. Atrial fibrillation was more likely to occur in the embolized group (P<0.05). Conclusion Atrial fibrillation in the patients with cardiac myxoma is closely related to embolic events. The size of myxoma is not related to the occurrence of embolic events.

关键词: 心脏粘液瘤; 栓塞; 临床特点

Key words: Cardiac myxoma; embolization; clinical features

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1. 唐颖. 心脏粘液瘤的发生、特征和分子生物学机制. 中国循环杂志, 2017, 32(7): 719-720.
2. Orlandi A, Ciucci A, Ferlosio A, et al. Cardiac myxoma cells exhibit embryonic endocardial stem cell features. J Pathol, 2006, 209(2): 231-239.
3. 王栋, 施苗, 张宇, 等. 左房粘液瘤所致后循环多发脑栓塞 1 例报告. 中风与神经疾病杂志, 2017, 34(6): 557-558.
4. Pucci A, Mattioli C, Matteucci M, et al. Cell differentiation in cardiac myxomas: confocal microscopy and gene expression analysis after laser capture microdissection. Heart Vessels, 2018, 33(11): 1403-1410.
5. Kayançiçek H, Khalil E, Keskin G, et al. Ten years’clinical experience of cardiac myxoma: diagnosis, treatment, and clinical outcomes. Anatol J Cardiol, 2018, 19(2): 157-158.
6. Zhang M, Ding L, Liu Y, et al. Cardiac myxoma with glandular elements: a clinicopathological and immunohistochemical study of five new cases with an emphasis on differential diagnosis. Pathol Res Pract, 2014, 210(1): 55-58.
7. Lee SJ, Kim JH, Na CY, et al. Eleven years’experience with Korean cardiac myxoma patients: focus on embolic complications. Cerebrovasc Dis, 2012, 33(5): 471-479.
8. 陈德助, 王建峰, 赵小平. 心脏黏液瘤致栓塞性脑血管病临床分析. 中华肿瘤防治杂志, 2015, 22(11): 43-44.
9. Nehaj F, Sokol J, Mokan M, et al. Outcomes of patients with newly diagnosed cardiac myxoma: a retrospective multicentric study. Biomed Res Int, 2018, 2018: 8320793.
10. 曹树刚, 徐文安, 翟明锋, 等. 以脑栓塞为首发症状的左房粘液瘤 2 例报告. 临床神经病学杂志, 2014, 27(5): 397-398.
11. 王秀芹, 武小玲. 彩色多普勒超声诊断心脏粘液瘤的临床价值研究. 国际医药卫生导报, 2016, 22(1): 102-105.
12. Lee HP, Cho WC, Kim JB, et al. Surgical Outcomes of cardiac myxoma: right minithoracotomy approach versus median sternotomy approach. Korean J Thorac Cardiovasc Surg, 2016, 49(5): 356-360.
13. 石磊. 国内全胸腔镜与传统开胸心脏手术的系统评价. 南昌大学医学院, 2013.
14. 贺清, 俞世强, 徐学增, 等. 完全胸腔镜与正中开胸治疗心脏粘液瘤的病例对照研究. 中国胸心血管外科临床杂志, 2016, (12): 1142-1145.
15. Dong NG, Zhang KL, Wu L, et al. Right anterolateral minithoracotomy versus median sternotomy approach for resection of left atrial myxoma. Thorac Cardiovasc Surg, 2018, 66(2): 193-197.