2024年6月26日 (三) 18:16的版本

原文：https://pubmed.ncbi.nlm.nih.gov/20807133/

Published：2010 Sep.

1 摘要 (Abstract)

病例描述：一只 10 岁的绝育雌性柯基犬被检查有 3 周的嗜睡和体重增加史。

临床表现：体格检查结果包括心音低沉、腹部膨胀，腹胀伴有液体波。胸部 X 线检查显示球状心脏轮廓，胸部超声检查显示心包积液和起源于右耳廓的带蒂肿块。

治疗和结局：初始治疗包括心包穿刺术。一周后，行胸腔镜右心房占位切除术。没有发现手术并发症，狗在手术后约 28 小时出院。肿块的组织学检查结果提示 2 级血管肉瘤，边缘不完全。手术后 35 天开始使用多柔比星治疗。这只狗在大规模切除后存活了 177 天，当时它因与转移性疾病相关的并发症而被安乐死。

临床相关性：研究结果表明，胸腔镜右心房肿块切除联合辅助阿霉素治疗可能是右心房肿块狗开胸术的可行替代方案。

Case description: A 10-year-old spayed female Corgi mix was examined for a 3-week history of lethargy and weight gain.

Clinical findings: Physical examination findings included muffled heart sounds and a distended abdomen with a fluid wave on ballottement. Thoracic radiography revealed a globoid cardiac silhouette, and thoracic ultrasonography indicated pericardial effusion and a pedunculated mass originating from the right auricle.

Treatment and outcome: Initial treatment consisted of pericardiocentesis. One week later, thoracoscopic right atrial mass resection was performed. No surgical complications were noted, and the dog was discharged approximately 28 hours after surgery. Results of histologic examination of the mass indicated a grade 2 hemangiosarcoma with incomplete margins. Treatment with doxorubicin was initiated 35 days after surgery. The dog survived for 177 days after mass resection, when it was euthanized because of complications related to metastatic disease.

Clinical relevance: Findings suggested that thoracoscopic right atrial mass removal combined with adjunct doxorubicin treatment may be a viable alternative to thoracotomy in dogs with right atrial masses.

2 概述

检查了一只 10 岁的 20.7 公斤（45.5 磅）绝育雌性柯基犬混合物，是否有 3 周的嗜睡和体重增加史。评估显示腹部膨大，可能存在脾脏肿块，腹部 X 线片显示明显腹腔游离液。病人被转诊到一家专科医院。

到达转诊医院后，这只狗很聪明，很警觉，反应灵敏。体格检查显示腹部膨大，血流波;在胸部听诊时听到低沉的心音。初始诊断性检查包括全血细胞计数、血清生化评估、胸部 X 线检查（右侧、左侧和腹背侧视图）、心电图以及胸部和腹部超声检查。

临床病理异常包括血小板减少症（167,000 血小板/μL;参考范围，200,000-500,000 血小板/μL）、低白蛋白血症（2.2 g/dL;参考范围，2.5-4.4 g/dL）、低蛋白血症（4.8 g/dL;参考范围，5.4-8.2 g/dL）和轻度高血糖（117 mg/dL;参考范围，60-110 mg/dL）。胸部 X 线片评估显示球状心脏轮廓。没有肿瘤性疾病的证据，肺野的影像学表现被认为在正常范围内。胸部超声检查提示心包积液，右耳廓附着 3.8 × 3.3 cm 的带蒂肿块。腹部超声检查显示肝脏充血，肝静脉和腹水扩张。脾脏和肾脏的超声检查无明显异常。初始心电图评估提示窦性心动过速，无室性搏动。

进行心包穿刺术，取出约 180 mL 出血液。由于患者举止安静，因此不需要镇静剂。术中偶有室性心动过速发作，心包穿刺术完成后2小时内偶见心室早搏。通过腹腔穿刺术获取腹液样本，并提交心包和腹液样本进行细胞学分析。心包积液由外周血和既往出血证据组成。观察到一些反应性间皮细胞，但没有肿瘤的证据。腹液被归类为具有非退行性中性粒细胞和反应性单核细胞的改良渗出物。狗在连续心电图监测下住院过夜;给予 50 mL/h （60 mL/kg/d [27.3 mL/lb/d]， IV） 和利多卡因 （100 μg/kg/min [45.5 μg/lb/min]， IV） 的平衡晶体液替代液a。这只狗在心包穿刺术后的第二天就出院了。出院前，与业主讨论了多种治疗方案，包括反复心包穿刺术和手术方案，例如姑息性心包切除术和心包切除术和肿块切除术。

一周后，狗被送回转诊医院进行胸腔镜心包切除术和右心房肿块切除术。主人报告说，这只狗在前一周在家里表现良好。用氢吗啡酮（0.05 mg/kg [0.023 mg/lb]，皮下注射）预先用药物，并用丙泊酚（5 mg/kg [2.3 mg/lb]，IV）和咪达唑仑（0.2 mg/kg [0.09 mg/lb]，IV）联合麻醉，并用异氟醚维持氧气。在麻醉诱导后，在手术开始前放置中心静脉导管（通过颈静脉）和动脉导管。手术开始前还进行了血型分析，发现狗的DEA 1.1阳性。手术前开始连续输注芬太尼（5 μg/kg/h，静脉注射）。头孢唑林（22 mg/kg [10 mg/lb]，静脉注射）在手术开始时给药。手术期间通过脉搏血氧饱和度、连续心电图和二氧化碳图对狗进行监测;用换能器测量动脉血压。在手术过程中进行手动通气，以控制肺部的整体充气，同时提供手术区域的充分可视化。

A 10-year-old 20.7-kg (45.5-lb) spayed female Corgi mix was examined for a 3-week history of lethargy and weight gain. Evaluation revealed a distended abdomen and possible splenic mass with free abdominal fluid evident on abdominal radiographs. The patient was referred to a specialty hospital.

On arrival at the referral hospital, the dog was bright, alert, and responsive. Physical examination revealed a distended abdomen with a fluid wave on ballottement; muffled heart sounds were heard during auscultation of the thorax. Initial diagnostic testing included a CBC, serum biochemical evaluation, thoracic radiography (right lateral, left lateral, and ventrodorsal views), electrocardiography, and thoracic and abdominal ultrasonography.

Clinicopathologic abnormalities included thrombocytopenia (167,000 platelets/μL; reference range, 200,000 to 500,000 platelets/μL), hypoalbuminemia (2.2 g/dL; reference range, 2.5 to 4.4 g/dL), hypoproteinemia (4.8 g/dL; reference range, 5.4 to 8.2 g/dL), and mild hyperglycemia (117 mg/dL; reference range, 60 to 110 mg/dL). Evaluation of thoracic radiographs revealed a globoid cardiac silhouette. There was no evidence of neoplastic disease, and the radiographic appearance of the lung fields was considered within normal limits. Thoracic ultrasonography indicated pericardial effusion with a 3.8 × 3.3-cm pedunculated mass attached to the right auricle. Abdominal ultrasonography revealed congestion of the liver with dilatation of the hepatic veins and ascites. Ultrasonographic appearance of the spleen and kidneys was unremarkable. Evaluation of an initial ECG indicated sinus tachycardia with no ventricular beats.

Pericardiocentesis was performed, and approximately 180 mL of hemorrhagic fluid was removed. Sedation was not required because of the patient's quiet demeanor. There were occasional episodes of ventricular tachycardia during the procedure, and an occasional premature ventricular complex was seen up to 2 hours after pericardiocentesis was completed. A sample of abdominal fluid was obtained via abdominocentesis, and the pericardial and abdominal fluid samples were submitted for cytologic analysis. The pericardial fluid consisted of a combination of peripheral blood and evidence of prior hemorrhage. Some reactive mesothelial cells were seen, but there was no evidence of neoplasia. The abdominal fluid was classified as a modified transudate with nondegenerative neutrophils and reactive mononuclear cells. The dog was hospitalized overnight with continuous ECG monitoring; balanced crystalloid replacement fluida at 50 mL/h (60 mL/kg/d [27.3 mL/lb/d], IV) and lidocaine (100 μg/kg/min [45.5 μg/lb/min], IV) were administered. The dog was discharged from the hospital the day after pericardiocentesis. Prior to discharge, multiple treatment options were discussed with the owner including repeated pericardiocentesis and surgical options such as palliative pericardiectomy and pericardiectomy with mass resection.

A week later, the dog was returned to the referral hospital for thoracoscopic pericardiectomy and right atrial mass resection. The owner reported that the dog had been doing well at home during the preceding week. The dog was premedicated with hydromorphone (0.05 mg/kg [0.023 mg/lb], SC), and anesthesia was induced with a combination of propofol (5 mg/kg [2.3 mg/lb], IV) and midazolam (0.2 mg/kg [0.09 mg/lb], IV) and was maintained with isoflurane in oxygen. A central venous catheter (via the jugular vein) and an arterial catheter were placed after anesthesia had been induced, prior to commencement of surgery. Blood typing was also performed before the start of surgery, and the dog was found to be DEA 1.1 positive. A continuous rate infusion of fentanyl (5 μg/kg/h, IV) was started before surgery. Cefazolin (22 mg/kg [10 mg/lb], IV) was administered at the start of surgery. The dog was monitored during surgery by use of pulse oximetry, continuous ECG, and capnography; arterial blood pressure was measured with a transducer. Manual ventilation was performed during surgery to control overall inflation of the lungs while providing adequate visualization of the surgical field.

将狗置于背卧位，并创建了一个膈下门户以插入 5 毫米胸腔镜。肋间门户在第五肋间隙双侧创建。解剖纵隔组织以允许心包可视化。切开心包，在膈神经腹侧建立一个 6 cm 的窗口。当心包被打开时，少量血液被释放到胸膜腔中。使用胸腔镜器械识别并切除右侧耳廓肿块，包括一个 45 毫米长的线性吻合器和 3.5 毫米的吻合器。放置胸腔造口管，并常规闭合胸腔。吸入胸腔造瘘管直至获得负压，然后通过胸腔造口管将布比卡因（2mg/kg [0.9mg/lb]）输注到胸膜腔中。

从麻醉中恢复是例行公事。将狗连接到连续心电图监护仪，并在手术后的前 2 小时内通过紧密贴合的面罩给予补充氧气。术后治疗包括静脉注射含电解质的等渗液体（50 mL/h）;连续输注芬太尼（2 至 5 μg/kg/h，静脉注射）、氯胺酮（2 μg/kg/min，静脉注射）和利多卡因（35 μg/kg/min [15.9 μg/lb/min]，静脉注射）;和头孢唑林的静脉给药（22 mg / kg，IV q 8 h）。在手术后的第一个小时内，每 15 分钟抽吸一次胸腔造口管，然后每小时抽吸一次，直到连续 4 小时内没有获得液体或空气。此后，每 6 小时吸入一次管子过夜。为了辅助疼痛控制，利多卡因（1 mg/kg [0.45 mg/lb]，胸腔内）和布比卡因（1 mg/kg，胸腔内）在管抽吸后每 6 小时通过胸腔造口管给药。

手术完成后 1 小时和 2 小时进行动脉血气分析。手术后 1 小时，O2 分压的肺泡-动脉梯度为 14 mm Hg（参考限值，< 15 mm Hg）;Pao2 和 Paco2 均在参考限值范围内。术后2小时，肺泡-动脉梯度、动脉pH值、Pao2、Paco2均在参考限值范围内。一夜之间，中心静脉压、动脉血压和连续心电图结果均在参考范围内。

手术后的第二天早上，这只狗很聪明，很警觉，反应灵敏。当时的体格检查显示肋间切口部位有一些轻微的渗出物，该部位被扩大以允许切除肿块，但其他方面结果并无明显异常。此时停止了对中心静脉压、动脉血压和心电图的连续监测。PCV为40%，总蛋白浓度为5.5 g/dL。停止监测前立即中心静脉压为 1 cm H2O。胸腔造口术插管被移除，因为一夜之间没有液体或空气通过管子吸入;最终剂量的利多卡因和布比卡因在取管前胸腔内给药。

这只狗在手术后的第二天继续表现良好。下午中午停止静脉注射头孢唑林、芬太尼、氯胺酮和利多卡因，口服曲马多（4 mg/kg [1.8 mg/lb]，PO，每 8 小时一次）以进一步控制疼痛。当晚晚些时候，这只狗出院了，并指示主人在14天后将其送回，进行后续检查和取出订书钉。

右心房肿块的组织学检查显示 2 级血管肉瘤，边缘不完全，主治病理学家表示肿瘤复发或转移的风险很高。当获得组织病理学检查结果时，这只狗被转介到内科讨论化疗方案。直到手术后 22 天，业主才安排与内科医生的初步咨询。

The dog was positioned in dorsal recumbency, and a subdiaphragmatic portal was created for insertion of a 5-mm thoracoscope. Intercostal portals were created bilaterally at the fifth intercostal space. Mediastinal tissues were dissected to allow for visualization of the pericardium. The pericardium was incised, and a 6-cm window was established ventral to the phrenic nerves. A small amount of bloody fluid was released into the pleural space as the pericardium was opened. The right auricular mass was identified and excised at its junction with the atrium by use of thoracoscopic instruments, including a 45-mm-long linear stapler with 3.5-mm staples.b The mass was removed via enlargement of one of the intercostal portal incisions and submitted for histopathologic examination. A thoracostomy tube was placed, and the thorax was closed routinely. The thoracostomy tube was aspirated until negative pressure was obtained, and bupivacaine (2 mg/kg [0.9 mg/lb]) was then infused into the pleural cavity via the thoracostomy tube.

Recovery from anesthesia was routine. The dog was connected to a continuous ECG monitor, and supplemental oxygen was administered for the first 2 hours after surgery via a tight-fitting face mask. Postoperative treatments included IV administration of isotonic fluids containing electrolytes (50 mL/h); continuous rate infusions of fentanyl (2 to 5 μg/kg/h, IV), ketamine (2 μg/kg/min, IV), and lidocaine (35 μg/kg/min [15.9 μg/lb/min], IV); and IV administration of cefazolin (22 mg/kg, IV q 8 h). The thoracostomy tube was aspirated every 15 minutes for the first hour after surgery and then hourly until no fluid or air was obtained over a continuous 4-hour period. Thereafter, the tube was aspirated every 6 hours overnight. For adjunctive pain control, lidocaine (1 mg/kg [0.45 mg/lb], intrapleurally) and bupivacaine (1 mg/kg, intrapleurally) were administered through the thoracostomy tube every 6 hours after tube aspiration.

Arterial blood gas analyses were performed 1 and 2 hours after the completion of surgery. One hour after surgery, the alveolar-arterial gradient in partial pressure of O2 was 14 mm Hg (reference limit, < 15 mm Hg); Pao2 and Paco2 were within reference limits. Two hours after surgery, the alveolar-arterial gradient, arterial pH, Pao2, and Paco2 were all within reference limits. Central venous pressure, arterial blood pressure, and results of a continuous ECG were all within reference limits overnight.

The morning following surgery, the dog was bright, alert, and responsive. Physical examination at that time revealed some mild oozing from the intercostal incision site that was enlarged to allow mass removal, but results were otherwise unremarkable. Continuous monitoring of central venous pressure, arterial blood pressure, and the ECG was discontinued at this time. The PCV was 40%, and total protein concentration was 5.5 g/dL. Central venous pressure was 1 cm H2O immediately prior to discontinuation of monitoring. The thoracostomy tube was removed because no fluid or air had been aspirated through the tube overnight; final doses of lidocaine and bupivacaine were administered intrapleurally just prior to tube removal.

The dog continued to do well the day after surgery. Intravenous administration of cefazolin, fentanyl, ketamine, and lidocaine was discontinued by midafternoon, and oral administration of tramadol (4 mg/kg [1.8 mg/lb], PO, q 8 h) was instituted for further pain control. The dog was discharged later that evening with directions that the owners return it 14 days later for a follow-up examination and staple removal.

Histologic examination of the right atrial mass revealed a grade 2 hemangiosarcoma with incomplete margins, and the attending pathologist remarked that there was a high risk of recurrence or metastasis of the tumor. The dog was referred to the internal medicine department for discussion of chemotherapy options when the results of histopathologic testing were obtained. The initial consultation with the internist was not scheduled by the owners until 22 days after surgery.

在肿块手术切除后 35 天开始用多柔比星治疗（30 mg/m^2，IV，每 3 周一次，共 5 剂）。进行全血细胞计数，并在每次给予多柔比星之前测量 PCV 和总蛋白浓度。每次结果都在参考限度内。在给予第二剂多柔比星之前，由于在给予第一剂多柔比星后出现恶心和呕吐的迹象，狗预先用马罗匹坦柠檬酸（1 mg/kg，SC）服药，并开具甲氧氯普胺（0.24 mg/kg [0.11 mg/lb]，PO，q 8 h）。相同的治疗方案用于随后的每次剂量的多柔比星。唯一报告的其他并发症是每次服用阿霉素后嗜睡 1 至 2 天。在用阿霉素治疗期间，狗的体重保持稳定，主人报告说狗在家里表现良好。

化疗结束后约50天（即手术后169天），狗被送回医院，主人主诉 2 至 3 天在兴奋和呼吸困难时咳嗽。这只狗在其他方面表现良好，食欲良好，活动水平正常。体格检查中发现的异常包括呼吸急促和刺耳的肺音。心脏听诊结果无明显异常。胸甲线检查显示所有肺野均有弥漫性粟粒状结节，与转移性血管肉瘤一致。泼尼松（1mg / kg，q 24小时，PO）用于缓解咳嗽。八天后，这只狗被重新检查，有咳嗽加重、呼吸急促和呼吸受损导致无法舒适睡眠的病史。当时，主人选择了对狗实施安乐死，因为生活质量下降和转移性疾病的证据。没有进行尸检。

Treatment with doxorubicin (30 mg/m2, IV, every 3 weeks, for a total of 5 doses) commenced 35 days after surgical resection of the mass. A CBC was performed, and PCV and total protein concentration were measured before each dose of doxorubicin was administered. Results were within reference limits each time. Before the second dose of doxorubicin was administered, the dog was premedicated with maropitant citratec (1 mg/kg, SC) because of signs of nausea and vomiting that had developed following administration of the first dose of doxorubicin, and metoclopramide (0.24 mg/kg [0.11 mg/lb], PO, q 8 h) was prescribed. This same treatment protocol was used for each subsequent dose of doxorubicin. The only other complication reported was lethargy for 1 to 2 days after administration of each dose of doxorubicin. The dog's weight remained stable during treatment with doxorubicin, and the owner reported that the dog was otherwise doing well at home.

Approximately 50 days after the conclusion of chemotherapy (ie, 169 days after surgery), the dog was returned to the hospital with a chief complaint by the owner of a 2- to 3-day history of coughing when excited and labored breathing. The dog had otherwise been doing well, with a good appetite and normal activity level. Abnormalities noted on physical examination included tachypnea and harsh lung sounds. Results of cardiac auscultation were unremarkable. Thoracic radiography revealed diffuse miliary nodules throughout all lung fields, consistent with metastatic hemangiosarcoma. Prednisone (1 mg/kg, q 24 h, PO) was prescribed for palliation of the cough. Eight days later, the dog was reexamined with a history of a worsening cough, tachypnea, and an inability to sleep comfortably owing to respiratory compromise. The owners elected euthanasia of the dog at that time because of a declining quality of life and evidence of metastatic disease. A necropsy was not performed.

3 Discussion

血管肉瘤是狗的常见肿瘤，约占所有非皮肤原发性恶性肿瘤的 5%[1] 血管肉瘤起源于血管内皮，已知会迅速转移[2-4] 常见的受累部位包括脾脏、右心房、皮下组织和肝脏[3-5] 血管肉瘤的常见并发症，无论位置如何，包括自发性出血和贫血[4] 这种类型的肿瘤与播散性肿瘤密切相关血管内凝血，血管肉瘤患者由于肿瘤内形成的异常血管的脆弱性，发生自发性出血的风险很高。心脏血管肉瘤的临床体征通常与心包积液和右侧充血性心力衰竭的体征有关，包括腹水、运动不耐受和呼吸困难[2] 体格检查的常见异常包括心音低沉、心动过速、黏膜苍白、股动脉搏动微弱、腹液波和呼吸困难[2,3]。

在本报告中描述的狗中，通过胸腔镜检查进行了心包次全切除术和右心房肿块切除术。胸腔镜检查以前被用作检查胸腔和获取活检标本的微创方法[6] 在人类医学中，胸腔镜检查被用于许多应用[7,8] 最近，人们对小动物的胸腔镜外科手术产生了兴趣，包括用于治疗心脏肿块出血或特发性心包积液的狗的次全心包切除术。一项研究[6] 涉及 13 只接受胸腔镜引导下心包切除术的肿瘤性或特发性心包积液狗，该研究的作者得出结论，这是一种可行的选择，与开胸术相比具有多项优势。没有发现麻醉并发症，13 只狗中只有 3 只出现手术并发症，包括膈神经横断、医源性肺撕裂伤和中度术中出血。12 只狗的恢复时间< 24 小时；1 只患有医源性肺撕裂伤的狗住院 36 小时[6] 这些结果[6] 和人类患者的结果[7-9] 表明，在正确选择的患者中，胸腔镜检查具有多种优势，主要优点是与开胸手术相比，手术的侵入性较小。胸腔镜手术的优点是切口部位小，不需要肋骨回缩。患者在手术后仍然需要放置胸腔造口管以允许从胸膜腔排出空气，但他们没有大切口的相关不适[10] 在之前的研究中[6] 涉及 13 只接受胸腔镜心包切除术的狗，报告的困难主要与所需视野的正确可视化有关。

狗心脏血管肉瘤的治疗可能包括药物和手术选择。许多患者在诊断时有转移的证据，这可能导致所有者选择姑息治疗，例如反复心包穿刺术，联合或不联合辅助化疗，而不是心包切除术和肿块切除术。在有转移性疾病证据的狗中，肿块切除术仅是姑息性的;因此，许多临床医生建议不进行切除肿块的次全心包切除术[3] 然而，最近一项针对 23 只接受正中胸骨切开术或侧开胸手术进行心包切除术和肿块切除术的狗的研究[3] 揭示了有希望的结果，23 只狗中有 20 只存活出院。

Hemangiosarcoma is a common neoplasm in dogs, representing approximately 5% of all noncutaneous primary malignant neoplasms.1 Hemangiosarcomas originate from vascular endothelium and are known to rapidly metastasize.2–4 Common sites of involvement include the spleen, right atrium, subcutaneous tissue, and liver.3–5 Common complications of hemangiosarcoma, regardless of location, include spontaneous hemorrhage and anemia.4 This type of neoplasm is strongly associated with disseminated intravascular coagulation, and patients with hemangiosarcoma are at high risk for spontaneous hemorrhage owing to the fragility of the abnormal vessels formed within the tumor. Clinical signs of cardiac hemangiosarcoma are generally related to pericardial effusion and signs of right-sided congestive heart failure, including ascites, exercise intolerance, and dyspnea.2 Common abnormalities on physical examination include muffled heart sounds, tachycardia, pale mucous membranes, weak femoral pulses, an abdominal fluid wave, and dyspnea.2,3

In the dog described in the present report, subtotal pericardiectomy and right atrial mass resection were performed by means of thoracoscopy. Thoracoscopy has been used previously as a minimally invasive way to examine the thoracic cavity and obtain biopsy specimens.6 In human medicine, thoracoscopy is being used for a number of applications.7,8 More recently, there has been interest in thoracoscopic surgical procedures in small animals, including subtotal pericardiectomy for the treatment of dogs with bleeding cardiac masses or idiopathic pericardial effusion. Authors of a study6 involving 13 dogs with neoplastic or idiopathic pericardial effusion that underwent thoracoscopic-guided pericardiectomy concluded that this was a viable option with several advantages over thoracotomy. No anesthetic complications were identified, and only 3 of the 13 dogs had procedural complications, including phrenic nerve transection, iatrogenic lung laceration, and moderate intraoperative bleeding. Recovery time was < 24 hours in 12 dogs; 1 dog with an iatrogenic lung laceration was hospitalized for 36 hours.6 These results6 and results from human patients7–9 indicate multiple advantages of thoracoscopy in properly selected patients, with the major advantage being the less invasive nature of the procedure when compared with thoracotomy. Thoracoscopic procedures have the advantage of small incision sites and do not require rib retraction. Patients still require placement of a thoracostomy tube after surgery to allow evacuation of air from the pleural cavity, but they do not have the associated discomfort of a large incision.10 In the previous study6 involving 13 dogs that underwent thoracoscopic pericardiectomy, reported difficulties were mainly associated with proper visualization of the desired field of view.

Treatment of cardiac hemangiosarcoma in dogs may include medical and surgical options. Many patients will have evidence of metastasis at the time of diagnosis, which may lead owners to opt for palliative treatments, such as repeated pericardiocentesis with or without adjunct chemotherapy, instead of pericardiectomy and mass resection. In dogs with evidence of metastatic disease, mass resection is only palliative; therefore, many clinicians recommend subtotal pericardiectomy without mass resection.3 However, a recent study3 of 23 dogs that underwent median sternotomy or lateral thoracotomy for pericardiectomy and mass removal revealed promising results, with 20 of the 23 dogs surviving to discharge from the hospital.

辅助化疗方案以前曾用于患有血管肉瘤的狗，但结果喜忧参半。据报道，基于多柔比星的方案具有中等疗效，但不包括多柔比星的方案对血管肉瘤的狗疗效有限或没有疗效.5 在一项仅限于患有心脏血管肉瘤的狗的研究中3，未经化疗的大规模切除后的平均生存时间为 46 天，而同样接受辅助化疗的狗的平均生存时间为 164 天。

据我们所知，这是第一份关于胸腔镜次全心包切除术和狗右心房肿块切除术的报道。本报告中的患者术后住院时间较短，无重大麻醉或手术并发症。我们患者手术的成功可能至少部分与外科医生在胸腔镜和微创外科手术方面的经验有关。安全地进行此类手术需要大量的培训和经验以及专业设备，在转诊患者进行类似治疗时应考虑这些因素。这只狗在大规模切除后的生存时间为 177 天，这与之前一项接受大规模切除和辅助化疗的右心房血管肉瘤狗的研究3 的平均生存时间相似。这些结果表明，对于患有右心房血管肉瘤的狗，胸腔镜肿块切除术可能是开胸术的可行替代方案。胸腔镜右心房肿块切除术的可能并发症与通过开胸术切除的肿块切除术相似，包括切除部位出血、心律失常和疼痛[3] 胸腔镜检查特有的并发症包括手术野可视化差和需要开胸手术的不受控制的出血。然而，在本报告中描述的狗中，没有出现这些并发症。在手术过程中可以看到完整的肿块，并且在肿块底部周围放置线性吻合装置没有发现任何问题。

Adjuvant chemotherapy protocols have been used previously in dogs with hemangiosarcoma with mixed results. Doxorubicin-based protocols reportedly have moderate efficacy, but protocols that do not include doxorubicin have had limited or no efficacy in dogs with hemangiosarcoma.5 In a study3 limited to dogs with cardiac hemangiosarcoma, mean survival time after mass resection without chemotherapy was 46 days, whereas mean survival time was 164 days for dogs that also received adjuvant chemotherapy.

To our knowledge, this is the first published report of a thoracoscopic subtotal pericardiectomy and right atrial mass resection in a dog. The patient in this report had a short postoperative hospitalization time and had no major anesthetic or operative complications. The success of the procedure in our patient was likely related, at least in part, to the experience of the surgeon in thoracoscopic and minimally invasive surgical procedures. Considerable training and experience and specialized equipment are required to safely perform this type of surgery, and these factors should be considered when referring a patient for similar treatment. Survival time in this dog after mass resection was 177 days, which was similar to mean survival time in a previous study3 of dogs with right atrial hemangiosarcoma that underwent mass resection and adjuvant chemotherapy. These results suggest that thoracoscopic mass resection may be a viable alternative to thoracotomy in dogs with right atrial hemangiosarcoma. Possible complications of thoracoscopic right atrial mass resection are similar to those associated with mass resection via thoracotomy and include bleeding from the resection site, cardiac arrhythmia, and pain.3 Complications unique to thoracoscopy include poor visualization of the surgical field and uncontrolled hemorrhage necessitating thoracotomy. However, in the dog described in the present report, none of these complications developed. The complete mass could be visualized during the procedure, and no problems were noted with placement of the linear stapling device around the base of the mass.

4 Reference

• 2000: Treatment of canine hemangiosarcoma: 2000 and beyond. Journal of Veterinary Internal Medicine 2000犬血管肉瘤的治疗：2000 年及以后兽医内科杂志
• 2014: Doxorubicin chemotherapy for presumptive cardiac hemangiosarcoma in dogs 阿霉素化疗治疗狗的推定性心脏血管肉瘤
• 2017: Comparison of doxorubicin-cyclophosphamide with doxorubicin-dacarbazine for HSA 多柔比星-环磷酰胺与多柔比星-达卡巴嗪辅助治疗犬血管肉瘤的比较

• 2013: 狗狗原发性心脏血管肉瘤的流行病学、临床和病理特征：51例的回顾。兽医学杂志 Epidemiological, clinical and pathological features of primary cardiac hemangiosarcoma in dogs: a review of 51 cases. 2013
• 2010: 狗的胸腔镜次全心包切除术和右心房肿块切除术

• [b] Hill’s Neoplasia Diet, Hill’s Pet Nutrition, Topeka, KS
• Nutritional Management of Patients with Neoplasia 小动物肿瘤患者的营养管理
• 狗狗心包积液