CAJ | 학술논문

目的探讨右心系统子宫静脉平滑肌瘤病(ICL)的诊断与手术治疗效果.方法 1995年2月至2011年6月收治ICL患者18例,术前诊断右心房黏液瘤2例,右心房或右心室内血栓2例,肺栓塞2例,下腔静脉和右心房肿瘤3例,下腔静脉占位病变9例.全组经心脏超声、磁共振、螺旋增强CT和血管造影检查.18例ICL均在全麻体外循环下经胸部切口,胸腹联合切口或腹部切口行平滑肌瘤切除术.结果全组无死亡.术后血管超声检查示右心房、下腔静脉、双侧肾静脉及双侧髂静脉内均未见肿瘤栓子.随访5 ～ 106个月,平均(49±42)个月,1例未完全切除肿瘤患者于术后5个月复发死亡,余17例随访无症状,术后心功能Ⅰ级10例,Ⅱ级7例.应用Kaplan - Meier生存曲线计算ICL术后5年生存率为(93±5)％.结论子宫静脉平滑肌瘤的诊断较困难,手术治疗可取得较好的中长期生存率和生存质量.
목적 탐토우심계통자궁정맥평활기류병(ICL)적진단여수술치료효과.방법 1995년2월지2011년6월수치ICL환자18례,술전진단우심방점액류2례,우심방혹우심실내혈전2례,폐전새2례,하강정맥화우심방종류3례,하강정맥점위병변9례.전조경심장초성、자공진、라선증강CT화혈관조영검사.18례ICL균재전마체외순배하경흉부절구,흉복연합절구혹복부절구행평활기류절제술.결과 전조무사망.술후혈관초성검사시우심방、하강정맥、쌍측신정맥급쌍측가정맥내균미견종류전자.수방5 ～ 106개월,평균(49±42)개월,1례미완전절제종류환자우술후5개월복발사망,여17례수방무증상,술후심공능Ⅰ급10례,Ⅱ급7례.응용Kaplan - Meier생존곡선계산ICL술후5년생존솔위(93±5)％.결론 자궁정맥평활기류적진단교곤난,수술치료가취득교호적중장기생존솔화생존질량.
Objective To investigate the diagnosis and surgical treatment for the intracardiac leiomyomatosis (ICL).Methods Retrospectively reviews the data of 18 cases of ICL from February 1995 to June 2011 in Anzhen Hospital.Preoperative diagnosis of right atrial myxoma in 2 cases,right atrium/ventricular thrombus in 2 cases,pulmonary embolism in 2 cases,the inferior vena cava and right atrial tumor in 3 cases,the inferior vena cava lesions in 9 cases.18 cases of ICL were diagnosed by echocardiography,magnetic resonance imaging ( MRI ),computer tomography (CT) and angiography.ICL were recected under anesthesia,cardiopulmonaray bypass surgery,he incisions were respectively through the chest,thoraco-abdominal or abdominal incision,cardiopulmonary bypass method were respectively at room temperature,mid-low temperature with cardiac arrest,lowflow,deep hypothermic circulatory arrest.Results There was no operative death.Right atrium,inferior vena cava,bilateral renal vein,bilater alIliac vein vascular were not found leiomyoma by vascular ultrasound.Follow-up time was 5 ～ 106 (49 ± 42 )months,1 patient died of the leiomyoma recurrence after 5 months after the primary operation,the remaining 17 patients were followed up asymptomatically.10 were in NYHA functional class Ⅰ,and 7 in class Ⅱ.The 5yrs survival rate calculated by the Kaplan-Meier survival curve was (93 ±5 )％.Conclusion The ICL preoperative diagnosis is difficult,surgical treatment of ICL can get a good mid-long term survival rate and living quality.