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目的探讨右侧心腔受累的静脉内平滑肌瘤病的诊断与外科治疗策略。方法选取北京协和医院2002年11月至2015年1月收治静脉内平滑肌瘤延伸至右侧心腔患者30例,对以下变量进行分析:年龄、应用体外循环患者的体外循环时间、停循环时间、肿瘤起源情况、术中出血量、术后住院时间、住院费用、是否存在下肢水肿、是否进行异体输血、术后并发症、肿瘤残留及复发情况等。结果 30例患者双下肢水肿者13例,27例应用体外循环,平均体外循环时间为(106.9±53.7)min,21例采用深低温停循环技术,平均停循环时间为(28.2±11.6)min。30例患者中9例肿瘤起源于生殖静脉,13例起源于髂静脉,8例既起源于生殖静脉、也起源于髂静脉。患者的术中出血量平均为(2060.5±2012.3)ml,21例患者进行输血治疗,术后平均住院时间为(18.9±8.3)d,平均住院费用为(80 840.4±28 264.2)元。14例患者术后出现并发症,无严重术后并发症,无1例死亡,随访至今情况良好。结论明确诊断,提高对肿瘤延伸侵入腔静脉及右心房的警惕性,对于右侧心腔受累的静脉内平滑肌瘤病患者,采用合理的手术策略,能达到完整切除肿瘤,确保患者安全的良好临床效果。切除附件对抑制肿瘤生长和避免复发至关重要。
Objective To investigate the diagnosis and surgical treatment of intravenous leiomyosarcoma with right ventricular involvement. Methods From November 2002 to January 2015, Peking Union Medical College Hospital, from November 2002 to January 2015, 30 patients with intravenous leiomyomas were enrolled in the right heart chamber. The following variables were analyzed: age, extracorporeal circulation time, cardiopulmonary bypass time , Tumor origin, blood loss, postoperative hospital stay, hospitalization costs, whether there is lower extremity edema, whether allogeneic blood transfusion, postoperative complications, tumor residual and recurrence and so on. Results Thirty patients had edema of lower extremities in 13 cases, 27 cases were treated with cardiopulmonary bypass, the mean time to cardiopulmonary bypass was (106.9 ± 53.7) min, 21 cases were treated with deep hypothermic circulatory arrest, and the mean circulatory arrest time was (28.2 ± 11.6) min. Nine of the 30 patients had their origin in the genital vein, 13 in the iliac vein, 8 in both the genital vein and the iliac vein. The mean intraoperative blood loss was (2060.5 ± 2012.3) ml. Twenty-one patients underwent blood transfusion. The mean length of stay after hospitalization was (18.9 ± 8.3) days and the average hospitalization cost was (80 840.4 ± 28 264.2) yuan. Complications were found in 14 patients without serious postoperative complications. None of them died, and their follow-up was good. Conclusions A clear diagnosis can improve the vigilance of extended tumor invading the vena cava and the right atrium. For the patients with intravenous leiomyoma who suffer from right ventricular involvement, a reasonable surgical strategy can achieve complete resection of the tumor to ensure the safety of the patient Clinical effect. Excision of attachments is crucial for inhibiting tumor growth and avoiding recurrence.