老年人心脏黏液瘤的临床特点与预后

摘要

目的探讨我国老年人心脏黏液瘤的临床特点、影像学特点及远期预后。方法收集1988年至2015年在解放军总医院住院手术的50例老年心脏黏液瘤患者病例资料，对其临床表现、影像学特点和远期预后进行回顾性分析。结果50例研究对象的平均年龄为（66．1±5．3）岁，其中女性16例。患者的病程平均为（15．7±21．7）年，临床症状表现为胸闷（20例）、心悸（20例）、呼吸困难（8例）、晕厥（8例）、脑栓塞（10例）、肢体栓塞（4例）、无力（14例）、发热（6例）、关节痛（4例）、无症状（6例）。X线胸片检查提示心脏肥大18例（36％）。超声心动图检查提示黏液瘤的好发位置依次为左心房44例（88％）、右心房2例（4％），左房室瓣前叶1例（2％），左心室1例（2％）。黏液瘤的平均体积为（33．04±13．81）cm3。50例患者术后随访1～26年，平均（11．3±12．3）年，无复发及进展为恶性肿瘤者；2例患者死亡（4％）。术后栓塞相关危险因素为晕厥和无力，死亡相关危险因素为关节痛、无力和黏液瘤体积较大。结论老年心脏黏液瘤患者临床症状不典型，常见临床症状为胸闷和心悸，好发于左心房，远期死亡率和复发率均较低。%Objective To explore the clinical features and prognosis of cardiac myxoma in the elderly patients. Methods A total of 50 elderly inpatients with cardiac myxoma were collected from December 1988 to December 2015 in PLA General Hospital.The clinical data,imaging characteristic and prognosis of patients with cardiac myxoma were analyzed retrospectively.Results The average age for patients was 66.12 ±5.34,and 16(32.0%)patients were fe-male.The mean disease course of cardiac myxoma was(15.8 ±21.7)years and the clinical manifestations include chest distress(20 cases),palpitations(20 cases),dyspnea(8 cases),syncope(8 cases),cerebral embolism(10 cases),limb embolism(4 cases),weakness(14 cases),fever(6 cases),arthralgia(4 cases)and asymptomatic(6 cases).Chest X-ray showed 18 patients(36%)with cardiac hypertrophy.Echocardiography showed the prediction sites of cardiac myxoma were left atrium 44(88%),right atrium 2(4%),left atrioventricular valve 1(2%)and left ventricular 1(2%).The av-erage volume of cardiac myxoma was(26.13 ±31.64)cm3.Patients were followed up for 1 to 26 years,and for an aver-age of 5.4(11.3 ±12.3)years postoperatively.Two patients died(4%),but no recurrence and no progression to malig-nancy was found during the followed up.The correlated risk factors of embolism were syncope and weakness,and the cor-related risk factors of death were joint pain,weakness and large size of cardiac myxoma.Conclusion The clinical symp-toms of cardiac myxoma in the elderly patients were not typica,and the common clinical symptoms were chest distress and palpitations.The cardiac myxoma most frequently involved the left atrium.The recurrence rate and long-term mortali-ty of cardiac myxoma after surgery were low.