心脏肿瘤临床剖析及误诊剖析60例.docVIP

心脏肿瘤临床剖析及误诊剖析60例 　　摘 要 目的：总结60例心脏肿瘤的临床特征，探讨误诊情况以提高诊断准确率。方法：回顾性分析60例心脏肿瘤患者的临床资料，着重分析临床特征、误诊情况。结果：60例患者均为超声心动确诊。误诊12例，误诊率20%，误诊时间4天～5个月，最多是脑栓塞。手术治疗50例，术后死亡1例，手术成功率98%，术后无并发症，转院2例，自动出院6例。结论：缺乏心脏黏液瘤的认识，未进行心脏彩超检查是其误诊的主要原因。其有效治疗为手术切除黏液瘤。 　　关键词 心脏肿瘤 误诊 诊断 　　doi:10.3969/j.issn.1007-614x.2012.07.056 　　Abstract Objective:To summarize the 60 cases of the clinical features of cardiac tumors,misdiagnosis and surgical experience.Methods:To retrospective analysis 60 cardiac tumors’ cases of our hospital from March 2003 to January 2011,analyzed the clinical features,misdiagnosis and surgical methods.Results:60patients were diagnosed by echocardiography.Surgical treatment of 50 cases,including 2 cases of thoracoscopic resection,1 patient died after surgery,surgical success rate was 98%(49/50),no postoperative complications,2 patients Transferred,6 patients discharged,2 patients was dead in few hours in hospital.9 cases were misdiagnosed,misdiagnosis rate was 15%(9/60),longest misdiagnosis time was 5 months,and most of them were caused by brain embolism.Conclusion:Cardiac myxoma are mostly common in Cardiac tumor,specially in women and left atrial;the most common misdiagnosis was cerebral embolism;surgery are the primary means of cardiac myxoma,the prognosis is excellent,the key of the surgery are early,complete,thorough resection.The future of minimally invasive treatment on cardiac myxoma is VATS. 　　Key Words Cardiac tumors;Misdiagnosed;Diagnose 　　心脏肿瘤在临床并不多见，由于肿瘤生长于心脏，即使良性肿瘤也可能对患者造成严重血流动力学影响，导致严重并发症，甚至危及生命，而且心脏肿瘤缺乏特殊的典型症状，早期诊断比较困难，因此了解心脏肿瘤的临床特点及治疗经验，为心脏肿瘤的诊治提供参考。 　　资料与方法 　　2003年3月～2011年1月收治心脏肿瘤患者60例，男36例，女62例；年龄2～71岁，平均45.02岁；病程4天～6年，所有患者均经超声心动确诊。 　　方法：通过查阅病案、归纳资料、进行描述性研究，以调查心脏肿瘤的临床特征、误诊情况等情况。 　　统计学处理：计数资料采用百分数表示，行X2检验。所有数据应用SPSS10.0统计软件进行处理与分析。 　　结 果 　　临床表现、辅助检查：本组心脏肿瘤中，以心悸、胸闷、气促表现为主41例，脑梗死9例，晕厥2例，关节疼痛、肢体栓塞、发热和浮肿各1例，无任何症状4例，心尖区闻及舒张期隆隆样杂音18例，收缩期杂音9例，双期杂音10例，而典型的肿瘤朴落音仅1例，杂音随体位变化4例，未闻及杂音12例，胸部X线片3例双肺瘀血。心电图不正常7例，主要表现为心房早搏、心房纤颤、电轴右偏、束支传导阻滞、心室高电压等。超声心动图检查均显示心腔内有肿块，并随心动周期而活