继发性心脏及心包肿瘤38例临床分析

时间 : 2009-11-27 01:41:24 来源：lw.china-b.com

[摘要]

关键词心脏，肿瘤；心包，肿瘤；恶性肿瘤ClinicalanalysisofsecondarytumorsofheartandpericardiumAbstractObjectiveTostudythediagn

关键词心脏，肿瘤；心包，肿瘤；恶性肿瘤

Clinicalanalysisofsecondarytumorsofheartandpericardium

AbstractObjectiveTostudythediagnosisandtherapyofsecondarytumorsofheartandpericardium.MethodsTheauthoranalyzedretrospectivelytheclinicaldataof38patientswithsecondarymalignantcardiacandpericardiumtumoradmittedtoourhospitalduring2001~2005.Theelectrocardiogram，theplainXray，echocardiography，CTwereutilizedasdiagnosticmodalitiesandpathologicalclassificationofthetumorswasmadebyexfoliativecytologicandhistologicalexamination.16patientsweretreatedbyoperationplustotalbodychemotherapyandradiotherapy;9patientsweretreatedwithtotalbodychemotherapyandradiotherapy;10patientswithpericardiumtamponadeweremadebypericardialsacdrainagelocalchemotherapyinpericardialcavity.13patientswhowereelderandcachexi，wereconservativelytreated.Results38patientswithsecondarymalignantcardiacandpericardiumtumorincluding25patientswithlungcancer，5patientswithmastocarcinoma，2patientswithesophagealcarcinoma，2patientswithlivercarcinoma，2patientswithpancreaticcarcinoma，1patientswithbileductcarcinoma，1patientswithsynoviosarcomaoflefttoe.Onlyoneof16patientswaslivingfor9years，otherssurvivedrangingfrom15daysto1years.13patientsunderwentconservativetreatmentsurvivedrangingfrom1weektohalfayear.ConclusionUCGarehelpfulandreliableforthediagnosisofsecondarymalignanttumorsofheart.Accuratediagnosisisonlymadebyhistologicalexamination.Mostofpatientswhoseprimarytumorwerediscoveredahead.Inminorityofpatientspericardiumtamponadewerefirstsymptem.Badprognsisisdispiteofallkindsoftherapy.Patientsaccompaniedwithpericardiumtamponadeshouldbetreatedbypericardialsacdrainage，localchemotherapyinpericardialcavitywhichcouldimprovesymptoms.

Keywordssecondaryhearttumor；pericardiummesothelioma

我院2000年1月~2005年1月共收治继发性心脏及心包肿瘤患者38例，均经病理诊断证实，现对其临床资料进行分析，告如下。

1对象与方法

1.1研究对象继发性心脏及心包肿瘤共38例，男23例，女15例，年龄43~75岁，平均59岁，其中肺癌25例，乳腺癌5例，食管癌2例，肝癌2例，胰腺癌2例，胆管癌1例，左足趾滑膜肉瘤1例。

1.2临床表现与实验室检查见表1。

表138例患者临床表现及医技科室检查情况与病理结果略

1.3方法本组患者先由X线及CT、超声、ECG检查，再经手术、穿刺抽液或活检做病理诊断，而确定诊断。38例患者中，16例行手术切除治疗，并给予全身化疗和放疗，包括肺癌9例，乳腺癌5例，胰腺癌1例，左足趾滑膜肉瘤1例；9例患者给予全身化疗和放疗，其中肺癌8例、食管癌1例；13例患者因年龄偏大、恶病质状态，给予对症、支持等保守治疗，包括肺癌8例，肝癌2例，食管癌1例，胰腺癌1例，胆管癌1例。具体化疗方案如下：肺癌患者中，黏液腺癌给予MVP，小细胞癌、神经内分泌癌给予足叶乙甙，顺铂，中分化鳞癌给予CAP；乳腺癌、左足滑膜肉瘤给予CAP；胰腺癌给予5-氟脲嘧啶、顺铂，配合放疗；食管癌给予放疗。心包填塞者，给予心包穿刺引流、心包腔内局部化疗。

继发性心脏及心包肿瘤38例，16例行手术切除治疗，并接受全身化疗和674.

5陈国伟，郑宗锷.现代心脏内科学.长沙：湖南科学技术出版社，1994，1129-1132.