上腔静脉综合征支架植入术后并发症分析  

Complications of stenting in superior vena cava syndrome

作　　者：孙勇[1] 倪才方[1] 周大勇[2] 沈利明[2] 蒋国民[3] 王凯[3] 

机构地区：[1]苏州大学附属第一医院介入科,215002 [2]苏州市立医院介入血管科 [3]江苏省常州市第二人民医院介入科

出　　处：《中华放射学杂志》2010年第2期176-180,共5页Chinese Journal of Radiology

摘　　要：目的探讨上腔静脉综合征（SVCS）支架植入术的并发症及其影响因素，以便制定合理的预防和处理措施。方法对39例不同原因所致的SVCS患者的临床资料进行回顾性分析。39例患者均行静脉造影，明确上腔静脉狭窄位置、程度、范围，然后行上腔静脉支架植入术。支架植入后以狭窄程度〈50％或狭窄程度减少20％以上，同时患者症状在治疗后短期缓解作为支架植入有效的标准，观察术后并发症情况。结果39例共植入支架40枚。术后35例患者症状明显好转，有效率89．7％（35／39）。6例发生并发症，发生率15．4％，其中1例因术后化疗有效、病变缩小致支架移位，症状未加重而未予处理；1例因未抗凝等后续治疗导致血栓形成，后行溶栓及放射治疗致支架移位，患者自动出院；1例因植人大网眼GianturcoZ形支架，肿瘤向网眼内生长导致再狭窄，患者自动出院；急性肺梗死及急性右心功能不全各1例，内科保守治疗后症状缓解；急性心包积液1例，急诊行心包抽液后症状缓解。结论SVCS支架植入术并发症种类较多，部分后果严重。需根据病因选择合适的治疗方法和合适的支架型号，术中操作轻柔仔细，重视术后处理等方能有效减少并发症。Objective To investigate the incidence and causes of complication of stenting in the treatment of superior vena cava syndrome （SVCS） for its proper prevetions. Methods Thirty nine patients with SVCS due to various diseases were retrospectively analyzed. The location, extension and degree of the stenosis were identified on venography before stent placement. Lumen narrowing becoming less than 50% or 20% improvement after stenting was taken as effective. Complications after stenting were analyzed. Results Thirty-five（89. 7%, 35/39） patients relieved after stenting. Six patients （ 15.4% ） had complications, including stents displacement due to mass lessened after chemotherapy in 1 cases, stents displacement and thrombogenesis due to lack of anticoagulant therapy and mass lessened after chemotherapy in 1 cases, restenosis due to mass growing into the screening of Gianturco Z-type stent in 1 cases, acute pericardial effusion in 1 cases, 1 of acute pulmonary embolism（PE） in 1 cases and acute congestive right heart failure and relieved after treatment in 1 cases. Conclusions Some complications of stenting in SVCS is serious. Proper procedure, stents selection and skillful handling can reduce the frequency of the complications.

关 键 词：上腔静脉综合征 放射学 介入性 支架 手术后并发症 

分 类 号：R543.6[医药卫生—心血管疾病]