2025 年第 8 期 第 20 卷

超声心动图在原发性右心室肿瘤诊断中应用价值分析

Analysis of the application value of echocardiography in the diagnosis of primary right ventricular tumors

作者：汤丽丽刘金凤李晓明于惠梅张纯

英文作者：Tang Lili Liu Jinfeng Li Xiaoming Yu Huimei Zhang Chun

单位：首都医科大学附属北京安贞医院介入超声科，北京100029

英文单位：Department of Interventional Ultrasound Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心脏肿瘤；右心室肿瘤；超声心动图

英文关键词：Cardiactumors;Rightventricletumors;Echocardiography

• 摘要：

• 目的 探讨超声心动图对原发性右心室肿瘤术前诊断价值。方法 回顾性分析2016年4月至2024年1月首都医科大学附属北京安贞医院30例经手术病理诊断原发性右心室肿瘤患者的临床表现、超声心动图特征。以病理结果为金标准，分析超声心动图对原发性右心室肿瘤的病理诊断符合率。结果  30例原发性右心室肿瘤患者，术后病理结果良性肿瘤24例（80.0%），恶性肿瘤6例（20.0%）。良性肿瘤包括黏液瘤11例，纤维瘤6例，横纹肌瘤4例，成熟型畸胎瘤1例、乳头状弹力纤维瘤1例和脂肪平滑肌瘤1例；恶性肿瘤包括未分化多形性肉瘤、血管肉瘤、滑膜肉瘤、黏液纤维肉瘤、平滑肌肉瘤、恶性血管内皮瘤各1例。术前超声心动图诊断与手术后病理诊断符合率36.7%（11/30）。黏液瘤超声心动图表现特异性强，超声心动图诊断与术后病理诊断符合率高（9/11），其特征性表现包括：中等回声，形态不规则，呈分叶状，有蒂附着，结构松散、活动度大、形态会随心动周期改变，舒张期瘤体不同程度嵌入瓣口，继发狭窄。恶性肿瘤组6例均无蒂，而良性肿瘤组有蒂者15例（62.5%），2组比较差异有统计学意义（P=0.017）。对良、恶性肿瘤组间进行超声心动图特征比较，恶性肿瘤组形态不规则5例，合并心包积液4例，活动度差5例，边界不清5例，三尖瓣反流4例，出现右心室流出道梗阻2例；良性肿瘤组形态不规则6例（25.0%），合并心包积液4例（16.7%），活动度差7例（29.2%），边界不清5例（20.8%），三尖瓣反流11例（45.8%），出现右心室流出道梗阻7例（29.2%）；2组形态不规则、合并心包积液、活动度差、边界不清比例比较，差异均有统计学意义（P=0.016、0.029、0.026、0.009）；出现三尖瓣反流和出现右心室流出道梗阻的比例比较，差异均无统计学意义（P=0.651、1.000）。结论  原发性右心室肿瘤以良性肿瘤多见，超声心动图能发现心腔内的占位性病变，提供肿瘤的位置、大小、形态和边界情况，更能提示心脏肿瘤对血流动力学是否造成影响，结合患者临床特征及超声心动图特点，可以进行初步病理性质的判断，对原发性右心室肿瘤具有一定的术前诊断价值。

• Objective To investigate the value of echocardiography in the preoperative diagnosis of primary right ventricular tumors. Methods The clinical manifestations and echocardiographic features of 30 patients with primary right ventricular tumors diagnosed by surgical pathology in Beijing Anzhen Hospital, Capital Medical University from April 2016 to January 2024 were retrospectively analyzed. With the pathological results  as the gold standard, the coincidence rate of echocardiography in the pathological diagnosis of primary right ventricular tumors was analyzed. Results Among 30 patients with primary right ventricular tumors, postoperative pathological results  showed that 24 cases (80.0%) were benign tumors and 6 cases (20.0%) were malignant tumors. Benign tumors included 11 cases of myxoma, 6 cases of fibroma, 4 cases of rhabdomyoma, 1 case of mature teratoma, 1 case of papillary elastofibroma and 1 case of lipoleiomyoma. Malignant tumors included undifferentiated pleomorphic sarcoma, angiosarcoma, synovial sarcoma, myxofibrosarcoma, leiomyosarcoma, and malignant hemangioendothelioma in 1 case each. The coincidence rate between preoperative ultrasound diagnosis and postoperative pathological diagnosis was 36.7% (11/30). The ultrasound features of myxoma were highly specific, and the coincidence rate of ultrasound diagnosis was 9/11. The characteristic manifestations of myxoma included: moderate echo, irregular shape, lobulated shape, pedicle attachment, loose structure, large activity, shape changes with the rhythm cycle, and the tumor was embedded into the valve orifice to varying degrees during diastole, and secondary stenosis. There were no pedicles in 6 cases of malignant tumors, while 15 cases (62.5%) of benign tumors had pedicles. There was significant difference between the two groups (P=0.017). The ultrasound echocardiographic features were compared between the benign and malignant tumor groups. In the malignant tumor group, there were 5 cases of irregular morphology, 4 cases of pericardial effusion, 5 cases of poor mobility, 5 cases of unclear boundaries, 4 cases of tricuspid regurgitation, and 2 cases of right ventricular outflow tract obstruction. In the benign tumor group, there were 6 cases (25.0%) with irregular morphology, 4 cases (16.7%) with pericardial effusion, 7 cases (29.2%) with poor mobility, 5 cases (20.8%) with unclear boundaries, 11 cases (45.8%) with tricuspid regurgitation, and 7 cases (29.2%) with right ventricular outflow tract obstruction. There were statistically significant differences in the proportion of irregular morphology, concomitant pericardial effusion, poor mobility, and unclear boundaries between the two groups (P=0.016, 0.029, 0.026, 0.009). There was no statistically significant difference in the proportion of tricuspid regurgitation and right ventricular outflow tract obstruction (P=0.651， 1.000). Conclusion Primary right ventricular tumors are mostly benign tumors. Echocardiography can find the space-occupying lesions in the cardiac cavity, provide the location, size, shape and boundary of the tumor, and also indicate whether the cardiac tumor has an impact on hemodynamics. Combined with the clinical characteristics of patients and echocardiography characteristics, preliminary pathological nature can be determined. It has a certain value in preoperative diagnosis of primary right ventricular tumors.