上腔静脉和无名静脉的切除及重建治疗纵隔肿瘤  

Extended Resection and Reconstruction of Superior Vena Cava and Innominate Vein for Mediastinal Tumor

作　　者：王振捷[1] 于洪泉[1] 任华[1] 张志庸[1] 李泽坚[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院心胸外科,北京100730

出　　处：《中国胸心血管外科临床杂志》2005年第1期22-25,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨分析纵隔肿瘤根治性切除 ,重建上腔静脉和无名静脉的手术意义及技术方法。　方法　回顾性分析北京协和医院 2 0 0 1～ 2 0 0 3年 11例纵隔肿瘤引起上腔静脉综合征患者的治疗及预后。根治性切除肿瘤 9例 ,其中 2例行心包修补静脉壁成形术 ,7例人工血管置换重建上腔静脉和无名静脉 ;2例部分切除。术中对左、右无名静脉分次阻断 ,单侧阻断时间 2 2 .15± 6 .2 9min,手术出血量 1342 .86± 6 92 .4 8ml。　结果　侵袭性恶性胸腺瘤 4例 ,胸腺癌5例 ,纵隔小细胞癌 2例。术后早期患者静脉梗阻症状即改善 ,无神经系统并发症 ,1例死于肺部感染 ,其余 10例全部健在 ,存活时间已达 6～ 30个月。　结论　上腔静脉和无名静脉的重建可以有效地消除上腔静脉综合征 ,其手术是安全的 ;但应注意病变的范围 ,争取根治性切除是提高生存率的关键。Objective To report the effect and experience of the extended resection and reconstruction of superior vena cava（SVC） and innominate vein for invasive mediastinal tumors. Methods A retrospective study of 11 patients who underwent extended resection and grafts of SVC and innominate vein for invasive mediastinal tumor in Peking Union Medical College Hospital from 2001 to 2003 was performed. Radical resection was performed in 9 eases, among which SVC and left innominate vein were reconstructed with pericardium patch in 2, with prostheses （ringed GoreTex） interposed in 7. The other 2 patients who had incomplete resection also underwent prostheses interposition for SVC reconstruction. During operation, SVC and left innominate vein were clamped in turn,to avoid total interruption of blood return, clamping time for each site was 22.15±6.29 min. The volume of blood loss was 1 342.86±692. 48ml during operation. Results The tumor included 4 invasive thymoma, 5 thymic cancer, 2 primary mediastinal small eell carcinoma. The patency was good in the grafts with external ring support and no SVC symptoms were observed in all cases postoperatively. One patient died of respiratory infection two weeks after operation, others are alive till now. The longest patent and functional graft is 30 months postoperatively.Conclusion SVC and innominate vein reconstruction by prostheses interposition can effectively eradicate the SVC syndrome. Clamping SVC needs careful study. Attention to the invasive cxtention of tumor should be made to avoid palliative operation,because complete resection is most important for long-term survival.

关 键 词：纵隔肿瘤 上腔静脉综合征 上腔静脉梗阻 上腔静脉重建 

分 类 号：R734.5[医药卫生—肿瘤]