上腔静脉综合征的外科治疗  

Surgical treatment of superior vena cava syndrome

作　　者：李遂莹[1] 袁五营[1] 高夏[1] 汤少鹏[1] 

机构地区：[1]河南省胸科医院胸外科,郑州450003

出　　处：《中国肿瘤临床与康复》2006年第1期50-52,共3页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的总结16例引起上腔静脉综合征的胸腔内恶性肿瘤扩大切除的治疗效果,探讨手术适应证以及上腔静脉人造血管置换术的操作要点。方法采用上腔静脉周围转移性肿大淋巴结剔除术共9例,上腔静脉侧壁部分切除修补术4例,人工血管上腔静脉置换术3例。结果16例全部实施临床根治性切除,无手术死亡。术前不同程度的上腔静脉梗阻症状全部缓解。术后发生并发症3例,发生率18.7%,均药物治愈。术后随访时间6个月至8年,随访15例,1例失访,随访率为93.8%。失访者按1年内死亡计,术后生存不足1年者3例(18.8%),>1年者13例(81.2%),>3年者6例(37.5%),>5年者2例(12.5%)。结论对于无远处转移侵犯上腔静脉的局部晚期恶性肿瘤,采用包括人工血管上腔静脉置换在内的扩大切除术,可以提高手术切除率,缓解临床症状,改善患者的生活质量,术后辅以化疗和放疗,有助于提高术后生存率。Objective To summarize the therapeutic efficacy of expanded resection of the malignant tumor in the thorax causing superior vena cava syndrome in 16 cases and to explore the operation indications and operation technique of replacing superior vena cava with artificial blood vessel. Methods Excision of metastatic enlarged lymph nodes around the superior vena cava was used in 9 cases. The part of side wall of superior vena cava was excised and repaired in 4 cases. The superior vena cava was replaced by artificial blood vessel in 3 cases. Results All 16 cases received radical excision and no operation death occurred. The symptoms of superior vena cava obstruction were all alleviated. Complications ocurred after operation in 3 cases,with an incidence of 18.7%, and all were cured with drugs. Fifteen patients were followed up for 6 months to 8 years after operation, and one patient was lost to follow up, with a follow-up rate of 93.8%. The patient lost to follow up was counted as death. Three patients（ 18.8% ） lived less than one year after operation, 13 patients （81.2% ） lived 〉 1 year,6 patients （ 37.5 % ） 〉 3 years and 2 patients （ 12.5 % ） 〉 5 years. Conclusions For local advanced malignant tumors invading superior vena cava without distant metastasis, expanded resection including replacement of superior vena cava with artificial blood vessel can raise operative excision rate, relieved clinical symptoms and improve patients＇ life quality. Adjuvant chemotherapy and radio- therapy after operation can help to improve postoperative survival rate.

关 键 词：肿瘤/外科学 上腔静脉综合征 

分 类 号：R730.5[医药卫生—肿瘤]