上腔静脉成形术在胸部恶性肿瘤治疗中的应用  

Application of reconstruction of superior vena cava in treatment of thoracic malignant tumors

作　　者：赵波[1] 付向宁[1] 韩东吉[2] 孙威[1] 张霓[1] 廖永德[1] 汤应雄[1] 陈启福[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院普胸外科,武汉430030 [2]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《临床外科杂志》2007年第9期615-617,共3页Journal of Clinical Surgery

摘　　要：目的探讨上腔静脉(SVC)置换或成形术治疗胸部恶性肿瘤侵及SVC患者的手术技术选择和麻醉管理特点。方法2000年1月至2006年10月行SVC成形或置换术治疗胸部恶性肿瘤侵及SVC患者73例,其中行肺切除(含支气管成形术)+SVC成形/置换术42例;纵隔肿瘤切除+SVC成形/置换31例。直接修复21例,SVC阻断下补片修补22例,腔内引流技术下补片修补15例;人造血管置换15例。结果手术死亡3例。术后所有患者SVC梗阻症状于24～48h内明显缓解,未见脑部损害及严重并发症。随访6～42个月,随访率78.57%,3个月后再发SVC梗阻症状患者1例;1年和2年生存率分别为74.55%和58.19%。结论肿瘤侵及SVC给外科手术带来一定的难度和风险,合理恰当的外科手术技术和麻醉管理可保障SVC重建术安全实施,改善患者生存质量,延长生存时间。Objective To discuss the operative technique and relative anaesthesia of reconstruction of superior vena cava （SVC） in the treatment of thoracic malignant tumors invading SVC. Methods From Jan. 2000 to Oct. 2006,73 patients with thoracic malignant tumors invading SVC underwent pneumonectory or resection of medlastinal tumors combined with partial resection and reconstruction of SVC. SVC - angioplasty was carried out in 21 cases directly, 22 cases with interdiction of SVC and 15 cases with a technique of intra - venous tube respectively. SVC - replacement was carried out in 15 cases. Results There were 3 operative deaths due to pulmonary embolism and severe pneumonia. Superior vena cava syndrome recurred in 1 patient 3 months after operation. The 1 - and 2 - year survival rate was 74.55 % and 58, 19 % respectively. Conclusion Resection of thoracic tumor combined with reconstruction of SVC can be performed with effective surgical and anaesthetic techniques and prolong survival time.

关 键 词：上腔静脉 胸部肿瘤 血管重建 麻醉 

分 类 号：R730.5[医药卫生—肿瘤]