累及心脏的血管内平滑肌瘤患者同期手术与分期手术的疗效比较

摘要

目的 探讨同期手术与分期手术治疗累及心脏的血管内平滑肌瘤(IVL) 患者的临床效果.方法 选取中国医学科学院北京协和医院2002年1月至2016年12月收治的累及心脏的IVL患者25例,根据是否同期手术切除平滑肌瘤分为同期手术组(10例) 和分期手术组(15例) .比较2组患者入院时一般情况、病史、临床表现、手术以及麻醉相关指标和术后随访时间、复发率及并发症发生率.结果 2组患者入院时一般情况、病史和临床表现比较差异均无统计学意义(均P > 0.05) .同期手术组术中失血量多于分期手术组[(5 621 ± 3 208) ml比(3 144 ± 2 059) ml,t = 2.360],手术时间、麻醉时间、总住院时间短于分期手术组[(528 ± 180) min比(618 ± 270) min、(600 ± 180) min比(732 ± 288) min、(28 ± 8) d比(48 ± 16) d],差异均有统计学意义(t = 2.757、2.769、-0.269,均P < 0.05) .2组患者术中体外循环时间、主动脉阻断时间、体外循环并深低温停循环时间和带管时间、重症监护病房停留时间以及血液回收机应用率和异体血输注率比较差异均无统计学意义(均P > 0.05) .同期手术组术后随访(22 ± 10) 个月,1例复发,伤口愈合不良2例; 分期手术组术后随访(21 ± 9) 个月,3例复发,肾积水、感染、盆腔感染各1例.2组患者术后随访时间、复发率及术后并发症发生率比较差异均无统计学意义(P = 0.851、0.626、0.050) .结论 对于累及心脏的IVL患者,同期手术与分期手术治疗效果无明显差异,但同期手术可缩短手术时间、麻醉时间和住院时间.%Objective To compare the clinical effects between one-stage and two-stage surgery of intracardiac leiomyomatosis. Methods Twenty-five cases of intracardiac leiomyomatosis in Peking Union Medical College Hospital,Chinese Academy of Medical Sciences between January 2002 and December 2016 were selected. According to the choice of surgical methods,the patients were divided into one-stage group(n = 10) and two-stage group(n = 15). General information,medical history,clinical manifestations,surgical and anesthetic data,postoperative follow-up data,recurrence rate and complication rate were analyzed. Results There was no significant difference of general information,medical history and clinical manifestations between groups(all P > 0.05). Amount of blood loss in one-stage group was significantly more than that in two-stage group[(5 621 ± 3 208) ml vs (3 144 ± 2 059) ml, t = 2.360]; operative time,anesthesia time,length of hospital stay in one-stage group were significantly shorter than those in two-stage group [(528 ± 180) min vs (618 ± 270) min,(600 ± 180) min vs (732 ± 288) min, (28 ± 8) d vs (48 ± 16) d](t = 2.757,2.769, -0.269; all P < 0.05). There was no significant difference of cardiopulmonary bypass time,aortic cross-clamping time,deep hypothermic circulatory arrest time,intubation time,intensive care unit stay time,autologous blood transfusion rate and allogeneic blood transfusion rate between groups(all P > 0.05). Follow-up time,recurrence and complications in one-stage group and two-stage group were (22 ± 10) months vs (21 ± 9) months,1 case vs 3 cases,2 cases(poor wound healing) vs 3 cases(hydronephrosis, infection,pelvic infection); there was no significant difference between groups (P = 0.851,0.626,0.050). Conclusions One-stage surgery and two-stage surgery show similar effect on intracardiac leiomyomatosis. One-stage surgery can reduce operative time,anesthesia time and length of hospital stay.