本文關(guān)鍵詞： 心臟腫瘤 診斷 治療 預(yù)后 兒童　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的總結(jié)與分析心臟腫瘤(CTs)患兒的臨床資料,為該病診治提供指導(dǎo)依據(jù)。方法收集1981年01月~2016年12月我院診治的53例CTs患兒的資料,歸納總結(jié)CTs的類(lèi)型、生長(zhǎng)特點(diǎn)和臨床表現(xiàn),評(píng)價(jià)超聲心動(dòng)圖(UCG)及磁共振顯像(MRI)的診斷價(jià)值;并根據(jù)治療方式將患兒分為手術(shù)治療組、非手術(shù)治療組和觀察組,隨訪2月~8年2月,分析各組患兒的預(yù)后。結(jié)果1.53例CTs中良性腫瘤45例(84.9%),包括橫紋肌瘤23例(43.4%),粘液瘤15例(28.3%),纖維瘤3例(5.7%),脂肪瘤、血管瘤、畸胎瘤、囊腫各1例(1.9%);惡性腫瘤8例(15.1%),包括轉(zhuǎn)移性心臟腫瘤(MCTs)7例(13.2%)、原發(fā)性心臟腫瘤(PCTs)1例(1.9%)。2.CTs的位置以多房室(16/53例,30.2%)最常見(jiàn),單發(fā)為主(33/53例,62.3%)。橫紋肌瘤均位于心室壁和(或)室間隔,常多發(fā)(17/23例,73.9%);粘液瘤多帶蒂(14/15例,93.3%),好發(fā)于心房(9/15例,60.0%);MCTs多位于右心房(6/7例,85.7%)。3.初診時(shí)無(wú)任何表現(xiàn)者8/53例(15.1%),存在心血管系統(tǒng)表現(xiàn)27/53例(50.9%)且以心臟雜音(20/27例,74.1%)最多,呼吸、神經(jīng)系統(tǒng)表現(xiàn)各15/53例(28.3%)。胸片、心電圖均無(wú)特異性。4.52/53例(98.1%)行UCG檢查,其中36/52例(69.2%)明確CTs類(lèi)型,7/52例(13.5%)診斷MCTs,9/52例(17.3%)診斷心臟占位性病變。13/53例(24.5%)行MRI檢查,均明確腫瘤性質(zhì),其中9/13例(69.2%)確定CTs類(lèi)型,1/13例(7.7%)囊腫誤診為粘液瘤。5.手術(shù)治療組16/53例(30.2%),遠(yuǎn)期隨訪死亡1/16例(6.3%),完全切除(13/16例,81.3%)或部分切除(3/16例,18.7%)對(duì)遠(yuǎn)期預(yù)后無(wú)影響(P=1.000)。非手術(shù)治療組17/53例(32.1%),其中放棄手術(shù)者死亡5/9例(55.6%),明顯多于手術(shù)治療組(P=0.012)。觀察組20/53例(37.7%)均為橫紋肌瘤,其中15例隨訪者均存活。結(jié)論小兒CTs大多呈良性,橫紋肌瘤最常見(jiàn)。臨床表現(xiàn)多樣且無(wú)特異性。UCG是初步評(píng)估CTs的首選檢查方法;MRI作為補(bǔ)充可進(jìn)一步鑒別CTs性質(zhì),明確橫紋肌瘤、纖維瘤等較常見(jiàn)的CTs類(lèi)型;病理組織檢查仍是診斷該病的金標(biāo)準(zhǔn)。小兒CTs的治療應(yīng)遵循個(gè)體化原則,對(duì)于腫瘤類(lèi)型特殊(粘液瘤、巨大纖維瘤、畸胎瘤等)或存在血流梗阻、明顯臨床表現(xiàn)的患兒,手術(shù)切除治療能有效緩解病情、改善預(yù)后,無(wú)手術(shù)治療指征者應(yīng)定期隨訪觀察。
[Abstract]:Objective to summarize and analyze the clinical data of children with cardiac neoplasms (CTS) and to provide guidance for the diagnosis and treatment of the disease. Methods 53 cases of CTs were collected from January 1981 to December 2016 in our hospital, and the types, growth characteristics and clinical manifestations of CTs were summarized. To evaluate the diagnostic value of echocardiography (UCG) and magnetic resonance imaging (MRI), and to divide the children into three groups according to the treatment methods: the operative group, the non-operative group and the observation group, followed up from February to February for 8 years. Results 1.Among 53 cases of CTs, 45 cases had benign tumors (84.9%), including 23 cases of transverse leiomyoma (23 cases), 15 cases of myoma (28. 3%), 3 cases of fibroma (5. 7%), lipoma, hemangioma, teratoma. One case of cysts, one case of cysts, one case of malignant tumor, eight cases of malignant tumor, including 7 cases of metastatic cardiac tumor, 7 cases of MCTsma, 1 case of primary cardiac tumor, 1 case of primary cardiac tumor, 1 case of PCTsT, 1 case of primary cardiac tumor and 1.99%. 2. The most common location of CTs was multiple atrioventricular septum (n = 1653), with 33 / 53 cases (62.33%). All striated leiomyomas were located in the ventricular wall and (or) ventricular septum, and most of them were located in the ventricular wall and (or) ventricular septum. There were 17 / 23 cases of myxoma with multiple pedicles, 15 cases with myxoma with multiple pedicle and 93% with myxoma, which occurred in 915% of the atrium in 60.015 cases. The MCTs were mostly located in the right atrium in 67 / 7 cases with 85.77.3.There were 8/53 cases with no manifestation at first visit, 27/53 cases with cardiovascular system and 50.9%), and the heart murmur was 20-27 cases with 74.1%. There were 15/53 cases of neurologic manifestations and 28.3% of the chest radiographs, none of which were specific. 4.52% of 53 cases (98.1%) were examined by UCG, of which 36/52 cases (69.2%) confirmed the type of CTs: 752 cases (13.5%).) 9 / 52 cases (17.3%) were diagnosed as cardiac occupying lesions. (13% 53 cases (24.5B) were examined with MRI, all of which were clear about the nature of the tumor. Among them, 9/13 cases (69.2%) were misdiagnosed as myxoma, 16/53 cases in the surgical treatment group, 1/16 cases died in long-term follow-up, 16 cases with complete resection of 13 / 13% (81.3%) or 18.7% with partial resection) had no effect on the long-term prognosis. 17/53 cases in the non-operative group had no effect on the long-term prognosis. Among them, 5/9 patients died of giving up the operation (55.6%), which was obviously more than that of the surgical treatment group (0.012%) and the observation group (20/53 cases (37.7%)) were all transverse striated leiomyomas. Conclusion most of the children with CTs are benign, and the most common of them are striated leiomyomas. The clinical manifestations are diverse and nonspecific. UCG is the first choice for the preliminary evaluation of CTs. It can be used to further differentiate the nature of CTs and determine the leiomyoma of transverse striatum. The pathological examination is still the gold standard for the diagnosis of the disease. The treatment of pediatric CTs should follow the principle of individualization, especially for the tumor type (myxoma, giant fibroma, teratoma, etc.) or the existence of blood flow obstruction. In children with obvious clinical manifestations, surgical resection can effectively alleviate the condition and improve the prognosis. The patients without indications of surgical treatment should be followed up regularly.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R732.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王靜蕾;孫愛(ài)敏;鐘玉敏;王謙;林毅;;MRI在小兒心臟腫瘤診斷中的應(yīng)用研究[J];中國(guó)醫(yī)療設(shè)備;2016年07期

2 張林妹;周淵峰;柴毅明;王佶;吳冰冰;王藝;周水珍;;結(jié)節(jié)性硬化105例臨床特征和基因型分析[J];中國(guó)循證兒科雜志;2016年03期

3 石琳;黃美容;劉春曉;郭穎;傅立軍;劉廷亮;高偉;李?yuàn)^;徐欣怡;章旭;陳樹(shù)寶;;兒童心臟腫瘤136例中長(zhǎng)期隨訪[J];中華實(shí)用兒科臨床雜志;2015年15期

4 劉旭;劉錦紛;;兒童原發(fā)性心臟腫瘤的診斷與治療[J];中華胸心血管外科雜志;2015年06期

5 仝開(kāi)軍;舒榮寶;程劉兵;;心臟血管瘤一例臨床病理及影像學(xué)分析并文獻(xiàn)復(fù)習(xí)[J];中華臨床醫(yī)師雜志(電子版);2015年01期

6 劉雪芹;;心臟橫紋肌瘤與結(jié)節(jié)性硬化癥[J];中華兒科雜志;2014年03期

7 陳芬;陳林林;譚偉兵;朱志農(nóng);張強(qiáng);;Gorlin綜合征的臨床表現(xiàn)[J];中國(guó)耳鼻咽喉頭頸外科;2012年09期

8 仇黎生;孫彥雋;丁文祥;徐志偉;劉錦紛;;小兒原發(fā)性心臟腫瘤27例分析[J];中華外科雜志;2011年03期

9 李志剛;徐志云;鄒良建;徐激斌;宋智鋼;;心臟粘液瘤新的分型探討——附復(fù)發(fā)性心臟粘液瘤二例報(bào)告及國(guó)內(nèi)文獻(xiàn)復(fù)習(xí)[J];中國(guó)胸心血管外科臨床雜志;2010年01期

10 王振平;孔祥泉;劉穎;劉定西;孔祥闖;徐海波;;原發(fā)性心臟腫瘤的MRI診斷[J];臨床放射學(xué)雜志;2009年06期

，

本文編號(hào)：1543421