超声心动显像评价心脏恶性肿瘤的手术、病理和尸检结果对照周维新杨浣宜张技革阮英卯李建蓉刘汉英王浩摘要目的:评价心脏恶性肿瘤的临床特点、手术所见、病理学类型、以及治疗情况;评价超声心动显像诊断心脏恶性肿瘤的准确性。方法:1983年至2002年12月在北京阜外心血管病医院手术和尸检及病理证实为心脏恶性肿瘤的患者27例。25例经手术和病理证实,2例尸检证实。24例为心脏原发恶性肿瘤,3例为转移性心脏恶性肿瘤。全部患者均有术前经胸超声心动显像检查资料。男17例,女10例。年龄1～72岁,平均34岁。结果:27例患者中,62195%肿瘤位于右心(右心房占33133%,右心室占14181%,浸润房室环及同时波及右房室占14181%。);29163%肿瘤位于左心(左心房占22122%,左心室占7141%);7141%位于心包。右心房肿瘤同时累及上腔静脉占14181%,累及下腔静脉占14181%,累及无名静脉占3170%。左心房肿瘤同时累及肺静脉占7141%。24例(88189%)原发心脏恶性肿瘤中,间叶肉瘤11例(40174%),血管肉瘤5例(18152%),横纹肌肉瘤2例(7141%),纤维肉瘤2例(7141%),平滑肌肉瘤1例(3170%),非何杰金氏恶性淋巴瘤1例(3170%),心包间皮肉瘤2例(7141%)。转移性心脏恶性肿瘤3例(11111%),其中转移性肝细胞癌2例占7141%,转移性上皮肉瘤1例占3170%。27例术前超声诊断均因缺乏经验,诊断心脏占位病变性质待定19例占70137%,诊断粘液瘤可能性大8例占29163%。结论:心脏恶性肿瘤多位于右心。不同类型的恶性肿瘤具有相似的超声所见,如肿块边界不规则、内部回声密度不均匀、多数较固定、肿块迅速增大等。一旦发现这些特点,应建议患者急诊或尽早手术。手术可清除肿瘤病灶,解除梗阻,延长患者的生命。关键词超声心动显像恶性肿瘤病理学作者单位:100037北京市,中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院超声科(周维新、杨浣宜、张技革、李建蓉、刘汉英、王浩),病理科(阮英卯)EchocardiographicEvaluatingCardiacMalignantTumors:ComparisonwithOperation,PathologyandAutopsyResultsZhouWeixin,YangHuanyi,ZhangJige,etalFuwaiHospital,CardiovascularInstitute,CAMSandPUMC,Beijing100037ChinaABSTRACTObjective:Toevaluateclinicalmanifestations,surgicalfindings,pathologictypesandtreatmentsofcardiacmalignanttumor.andtoanalyzetheirechocardiographiccharacteristics.Methods:Recordsof27patientswithcardiacmalignanttumorsconfirmedbyoperations,pathologyandautopsiesatFuwaiCardiovascularHospitalinBeijing,ChinabetweenJan,1983andDec,2002werereviewed1Clinicalandechocardiographicdataofallpatientswereabstracted1Twentyfive(25�27)patientswereconfirmedbyoperationsandpathology;two(2�27)patientsbyautopsy1Twentyfour(24�27)patientswerewithprimarycardiacmalignanttumors,three(3�27)patientswerewithsecondarycardiactumors.Results:Medianageof27patientswas34yr1(ranging:1～72yr1)1Maleandfemalewere17and10casesrespectively1Thesurgicalfindingsrevealedthat62196%ofmalignanttumorswerefoundinrightheart,(33133%inrightatria,14181%inrightventricles,14181%inatriaventricularannuliandrightatriaandventricles),29163%inleftheart(22122%inleftatria,7141%inleftventricles),7141%inpericardium1Thepathologyrevealedthat24cases(88189%)werediagnosedasprimarymalignanttumorsincluding11(40174%)mesenchymalsarcomas,5(18152%)angiosarcomas,2(7141%)rhabdomyosarcomas,2(7141%)fibrosarcomas,1(3170%)leiomyosarcoma,1(3170%)non2Hodgkin’slymphosarcomaand2(7141%)mesotheliosarcomasofpericardium1Threecases(11111%)werediagnosedasmetastaticcardiacmalignanttumorsbypathology,2(7141%)metastatichepatocellularcarcinomas,and1(3170%)metastaticepithelioidsarcoma1Wewerelackinexperienceusingechocardiographyfordiagnosingcardiacmalignanttumorsbeforeoperation:nineteencases(19�27,70137%)were—83—中国超声医学杂志2004年第20卷第1期ChineseJUltrasoundMedVol20No12004diag...
