经腹一期手术切除累及心脏的静脉内平滑肌瘤病可行性探讨
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摘要
目的探讨经腹一期手术切除累及心脏的静脉内平滑肌瘤病的可行性。方法回顾性分析2015年12月到2017年8月复旦大学附属中山医院收治的4例经腹部切口一期手术切除累及心脏的静脉内平滑肌瘤病病人的临床资料。结果 4例病人均一期完成经腹手术,无死亡病例。手术时间185～420 (315.3±86.4)min,体外循环时间22～175(71.8±60.4)min,出血量600～3000(1475.0±941.7)mL。1例病人术后出现急性肾功能损伤,其余病人均无手术并发症。术后随访8～26个月,中位随访时间14个月,4例病人均无复发或转移。结论经腹一期手术切除累及心脏的静脉内平滑肌瘤病安全可行,但如何正确把握手术适应证还有待进一步探索和研究。
Objective To investigate the feasibility of abdominal surgical resection of intracardiac leiomyomatosis.Methods The clinical data of 4 cases of intracardiac leiomyomatosis performed in zhongshan Hospital,Fudan University from December 2015 to August 2017 were analyzed retrospectively. Results Four patients underwent onestage surgery through an abdominal approach,without death. The operative time was 185-420(315.3 ± 86.4) min.Extracorporeal circulation time was 22-175(71.8±60.4)min and blood loss was 600-3000(1475.0±941.7)mL. Acute renal failure occurred in one of the patients after operation,the rest had no surgical complications. After 8-26 months of follow-up,there was no sign of recurrence and metastasis. Conclusion One-stage surgery of intracardiac leiomyomatosis through an abdominal approach is feasible. But,how to determine the indications of surgery remains to be further explored and studied.
Objective To investigate the feasibility of abdominal surgical resection of intracardiac leiomyomatosis.Methods The clinical data of 4 cases of intracardiac leiomyomatosis performed in zhongshan Hospital,Fudan University from December 2015 to August 2017 were analyzed retrospectively. Results Four patients underwent onestage surgery through an abdominal approach,without death. The operative time was 185-420(315.3 ± 86.4) min.Extracorporeal circulation time was 22-175(71.8±60.4)min and blood loss was 600-3000(1475.0±941.7)mL. Acute renal failure occurred in one of the patients after operation,the rest had no surgical complications. After 8-26 months of follow-up,there was no sign of recurrence and metastasis. Conclusion One-stage surgery of intracardiac leiomyomatosis through an abdominal approach is feasible. But,how to determine the indications of surgery remains to be further explored and studied.
引文
[1]李春民,张望德.下腔静脉平滑肌瘤病临床特点及研究进展[J].中国血管外科杂志电子版,2015,7(3):198-201.
[2]Barksdale J,Abolhoda A,Saremi F.Intravenous leiomyomatosis presenting as acute Budd-Chiari syndrome[J].J Vasc Surg,2011,54(3):860-863.
[3]Wang J,Yang J,Huang H,et al.Management of intravenous leiomyomatosis with intracaval and intracardiac extension[J].Obstet Gynecol,2012,120(6):1400-1406.
[4]Okada M,Miyoshi Y,Kato G,et al.Successful one-stage surgical removal of intravenous leiomyomatosis with cardiac extension in an elderly patient[J].Gen Thorac Cardiovasc Surg,2012,60(3):153-156.
[5]Price JD,Anagnostopoulos C,Benvenisty A,et al.Intracardiac Extension of Intravenous Leiomyomatosis[J].Ann Thorac Surg,2017,103(2):145-147.
[6]Clay TD,Dimitriou J,Mcnally OM,et al.Intravenous leiomyomatosis with intracardiac extension-a review of diagnosis and management with an illustrative case.[J].Surg Oncol,2013,22(3):44-52.
[7]Rispoli P,Santovito D,Tallia C,et al.A one-stage approach to the treatment of intravenous leiomyomatosis extending to the right heart[J].J Vasc Surg,2010,52(1):212-217.
[8]马国涛,苗齐,任华,等.腔静脉瘤栓延伸至右侧心腔的诊断和外科治疗[J].基础医学与临床,2009,29(4):431-435.
[9]Ta?delen A,Mercan AS,Sezgin A,et al.Two discrete masses of leiomyomatosis in a patient,one extending to the right atrium.[J].Thorac Cardiovasc Surg,2000,48(3):161-163.
[10]Nili M,Liban E,Levy MJ.Tricuspid stenosis due to intravenous leiomyomatosis--a call for caution:case report and review of the literature.[J],Tex Heart Inst J.1982,9(2):231-235.
[11]Harris LM,Karakousis CP.Intravenous leiomyomatosis with cardiac extension:tumor thrombectomy through an abdominal approach[J].J Vasc Surg,2000,31(5):1046-1051.
[12]Matsuo K,Fleischman F,Ghattas CS,et al.Successful extraction of cardiac-extending intravenous leiomyomatosis through gonadal vein[J].Fertil Steril,2012,98(5):1341-1345.
[13]陈唯韫,朱斌,刘兴荣,等.经食管超声心动图用于累及右心的下腔静脉瘤栓切除术的临床价值[J].中华麻醉学杂志,2014,34(5):593-596.
[2]Barksdale J,Abolhoda A,Saremi F.Intravenous leiomyomatosis presenting as acute Budd-Chiari syndrome[J].J Vasc Surg,2011,54(3):860-863.
[3]Wang J,Yang J,Huang H,et al.Management of intravenous leiomyomatosis with intracaval and intracardiac extension[J].Obstet Gynecol,2012,120(6):1400-1406.
[4]Okada M,Miyoshi Y,Kato G,et al.Successful one-stage surgical removal of intravenous leiomyomatosis with cardiac extension in an elderly patient[J].Gen Thorac Cardiovasc Surg,2012,60(3):153-156.
[5]Price JD,Anagnostopoulos C,Benvenisty A,et al.Intracardiac Extension of Intravenous Leiomyomatosis[J].Ann Thorac Surg,2017,103(2):145-147.
[6]Clay TD,Dimitriou J,Mcnally OM,et al.Intravenous leiomyomatosis with intracardiac extension-a review of diagnosis and management with an illustrative case.[J].Surg Oncol,2013,22(3):44-52.
[7]Rispoli P,Santovito D,Tallia C,et al.A one-stage approach to the treatment of intravenous leiomyomatosis extending to the right heart[J].J Vasc Surg,2010,52(1):212-217.
[8]马国涛,苗齐,任华,等.腔静脉瘤栓延伸至右侧心腔的诊断和外科治疗[J].基础医学与临床,2009,29(4):431-435.
[9]Ta?delen A,Mercan AS,Sezgin A,et al.Two discrete masses of leiomyomatosis in a patient,one extending to the right atrium.[J].Thorac Cardiovasc Surg,2000,48(3):161-163.
[10]Nili M,Liban E,Levy MJ.Tricuspid stenosis due to intravenous leiomyomatosis--a call for caution:case report and review of the literature.[J],Tex Heart Inst J.1982,9(2):231-235.
[11]Harris LM,Karakousis CP.Intravenous leiomyomatosis with cardiac extension:tumor thrombectomy through an abdominal approach[J].J Vasc Surg,2000,31(5):1046-1051.
[12]Matsuo K,Fleischman F,Ghattas CS,et al.Successful extraction of cardiac-extending intravenous leiomyomatosis through gonadal vein[J].Fertil Steril,2012,98(5):1341-1345.
[13]陈唯韫,朱斌,刘兴荣,等.经食管超声心动图用于累及右心的下腔静脉瘤栓切除术的临床价值[J].中华麻醉学杂志,2014,34(5):593-596.