2020 年第 9 期 第 15 卷

超声心动图对小儿心脏肿瘤的诊断价值

The value of echocardiography in the diagnosis of cardiac tumors in children

作者：李文秀1王兆富2苏俊武1耿斌1杨爽1吴江1

英文作者：Li Wenxiu1 Wang Zhaofu2 Su Junwu1 Geng Bin1 Yang Shuang1 Wu Jiang1

单位：1首都医科大学附属北京安贞医院小儿心脏中心100029；2山东省潍坊市妇幼保健院超声科261011

英文单位：1 Pediatric Cardiology Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Ultrasound Weifang Maternal and Child Health Hospital Shandong Province Weifang 261011 China

关键词：小儿心脏肿瘤；横纹肌瘤；黏液瘤；超声心动图

英文关键词：Pediatriccardiactumors;Rhabdomyomas;Myxomas;Echocardiography 

• 摘要：

• 目的 探讨不同年龄段未手术小儿心脏肿瘤患儿的超声心动图诊断结果及手术患儿的术后病理。方法 选取2005年5月至2020年1月于首都医科大学附属北京安贞医院小儿心脏中心住院治疗的心脏肿瘤患儿40例，行手术治疗24例（手术组），未手术16例（未手术组）。分析手术组患儿的手术方式及术后病理，未手术组患儿的超声心动图及心脏CT诊断结果，总结患儿的随访情况。结果手术组1例行右侧腋下小切口手术，其余均为胸部正中切口；20例行肿瘤完整切除术，4例行部分切除术。术后病理显示良性病变19例，恶性病变1例，生物学行为未明确4例,其中婴幼儿病理结果为横纹肌瘤5例、炎性肌纤维母细胞瘤2例、血栓1例；儿童及少年病理结果为黏液瘤7例，纤维瘤3例，炎性肌纤维母细胞瘤2例，横纹肌瘤、血管瘤、畸胎瘤、纤维肉瘤各1例。未手术组婴幼儿超声心动图及CT诊断为横纹肌瘤9例、性质待定2例；儿童及少年超声心动图诊断为畸胎瘤2例、横纹肌瘤3例。结论 婴幼儿心脏肿瘤主要为横纹肌瘤，瘤体较小且无明显临床症状者可暂缓手术治疗，部分横纹肌瘤患儿出生后瘤体有逐渐缩小、消失的特点，对血流动力学不稳定的肿瘤应积极手术切除,儿童及少年心脏肿瘤以黏液瘤更常见，经胸常规超声心动图仍是小儿心脏肿瘤首要的检查手段。产前超声心动图可为心脏横纹肌瘤胎儿的产前诊断、咨询和预后评估提供重要依据。

• Objective To investigate the value of echocardiography in the diagnosis of cardiac tumors in children and the postoperative pathology of children after operation. Methods From May 2005 to January 2020， 40 hospitalized children with pediatric cardiac tumors admitted to pediatric cardiology center of Beijing Anzhen Hospital, Capital Medical University were selected. Twenty-four patients with surgical treatment were in surgery group, and 16 cases without operation were in non-surgery group. The surgical methods and postoperative pathology in surgery group, the echocardiography and cardiac CT diagnosis results in non-surgery group were analyzed, and the follow-up results were summarized. Results In the surgery group, 1 child received right subaxillary small incision, and the rest received median thoracic incision. Total tumor resection was performed for 20 patients and partial resection for 4 patients. Postoperative pathology showed 19 cases of benign lesions, 1 case of malignant lesions and 4 cases of unclear biological behavior, including 5 cases of rhabdomyoma, 2 cases of inflammatory myofibroblastoma and 1 case of thrombus. The pathological results of children and adolescents were 7 cases of myxoma, 3 cases of fibroma, 2 cases of inflammatory myofibroblastoma, rhabdomyoma, hemangioma, teratoma and fibrosarcoma in 1 case respectively. In no-surgery group, 9 cases of rhabdomyoma and 2 cases of specific nature were diagnosed by echocardiography and CT, 2 cases of teratoma and 3 cases of rhabdomyoma were diagnosed by echocardiography in children and adolescents. Conclusions Cardiac tumors in infants are mainly rhabdomyosomas. A small tumor without obvious clinical symptoms, the surgical treatment can be postponed. Some rhabdomyomas have the characteristics of gradual shrinkage and disappearance after birth. The tumors of some rhabdomyoma children have the characteristics of gradually shrinking and disappearing after birth. The tumors with hemodynamic instability should be resected actively, and myxoma is more common in children and adolescents. Transthoracic echocardiography is still the primary examination method for cardiac tumors in children. Prenatal echocardiography can provide important basis for prenatal diagnosis, counseling and prognosis assessment of cardiac rhabdomyoma fetuses.