心脏内平滑肌病的临床特点及外科治疗

目的总结心脏内平滑肌瘤病（intracardiac leiomyomatosis,ICL）的临床特点及外科治疗经验。方法回顾分析1999年1月至2009年1月新乡医学院第一附属医院收治的5例心脏内平滑肌瘤病患者的临床资料。结果 5例患者均为女性,有明显心慌、胸闷、晕厥或静脉栓塞等症状。影像学检查在右房及下腔静脉发现瘤栓。其中4例有＂子宫肌瘤手术史＂,1例入院后B超检查发现＂子宫肌瘤＂。5例患者均接受手术治疗,其中1例行单纯心房内瘤体切除,半年后病变复发,再次手术后死于多器官功能衰竭。4例经胸腹联合切口行分期根治术,一期完整切除右房及下腔静脉内所有瘤体,6～9个月后由妇产科行二期手术治疗原发病灶,随访2年,心脏及下腔静脉内均无肿瘤复发,无明显临床症状。结论心脏平滑肌瘤临床发病率低,手术是最主要的治疗方法,彻底切净肿瘤是成功治疗的关键。

The Clinical Feature and Surgical Treatment of Intracardiac Leiomyomatosis

Objective To summarize the clinical feature,diagnosis and treatment of intracardiac leiomyomatosis.Methods A retrospective analysis was performed on 5 patients of ICL during the period of 1999～2009 in first affiliated hospital of Xinxiang Medical College cardiac surgery.Results All 5 patients presented with cardiac symptoms associated with a right atrial mass.who also had a hysteromyoma or who had previously undergone hysterectomy because of leiomyoma uteri.They were all treated with surgical resection within a short interval.One patient only been resected tumor in her right atrium,But the turom stared again six months later,Finally she died of multiple organ failure when received another operation.Another four removed the turom in right atrium and inferior vena cave thoroughly,And also received continuous therapy in department of gynaecology 6～9months later. Two years follow up echocardiography data showed there were no turom recurrence.Clinical symptom was completely disappeared.Conclusion ICL is a rare benign smooth muscle tumor.Surgical resection is the most optimum therapy.Excision thoroughly is the key to improve the prognosis.