恶性肿瘤静脉血管并发症的介入治疗  

Interventional treatment for venous vascular complications of malignant tumor

作　　者：肖亮[1] 申景[1] 童家杰[1] 解世洋[2] 魏东升[3] 

机构地区：[1]中国医科大学附属第一医院,110001 [2]中国医科大学 [3]内蒙古自治区通辽市医院

出　　处：《山西医药杂志（上半月）》2011年第4期326-329,共4页Shanxi Medical Journal

基　　金：国家"十一五"科技支撑计划(2007BAI05B04)

摘　　要：目的探讨恶性肿瘤静脉血管并发症介入治疗的疗效及安全性问题。方法 2001年10月至2009年9月于我院就治的恶性肿瘤静脉血管并发症患者49例,受累部位：颈静脉3例,上肢静脉8例,上腔静脉24例,下腔静脉5例,门静脉癌栓4例,髂静脉5例。分别采用腔静脉滤器置入及静脉置管溶栓术、静脉球囊成形及支架置入术进行治疗。术后给予抗凝、抗炎治疗5~7 d。随访3~12个月。结果 49例患者中,13例行滤器置入及静脉置管溶栓术,技术成功率100%;平均静脉置管溶栓时间7.38 d;临床症状完全消失11例,明显好转2例。36例患者行静脉球囊成形及支架置入术,技术成功率为94%;临床症状完全消失21例,明显好转13例,无明显变化2例。术中无出现血管穿孔、破裂等介入操作相关并发症。术后未出现肺动脉栓塞的临床表现。随访47例,13例患者因原有肿瘤进展而死亡,3例再次出现临床症状,31例患者血管超声提示治疗部位静脉血流通畅。结论介入技术治疗恶性肿瘤静脉血管并发症创伤小、耐受性好、症状改善明显、技术成功率高,具有良好的临床应用价值。Objective To explore the efficacy and safety of interventional treatment for venous vascular complications of malignant tumor.Methods Fouty-nine patients with venous vascular complications of malignant tumor were treated in our hospital from October 2001 to September 2009.The onset time is from 7 day to 3 months.Involved veins included jugular veins（3 cases）,upper extremity veins（8 cases）,SVC（24 cases）,IVC（5 cases）,portal veins（4 cases） and iliac veins（5 cases）.The interventional therapeutic operations included vena cava filter implantation,transcatheter thrombolytic therapy,PTA and stent.All patients accepted anticoagulation and antibiotic treatment for 5～7 days after operation.Followed-up were 3～12 months.Results In all 49 patients,13 patients accepted vena cava filters implantation and transcatheter thrombolytic therapy and their success rate was 100%,average thrombolysis period was 7.38 days（5～10 days）.Before stopping thrombolytic therapy,11 patients′ symptoms disappeared,2 patients′ symptoms palliated and 10 patients′ thrombus were almost completely dissolved,3 patients＇ thrombus were partial dissolved.Thirty-six patients accepted PTA and stent implant therapy and their success rate was 94%.After therapy,21 patients＇ symptoms disappeared,13 patients′ symptoms palliated and 2 patients′ symptoms did not change.There were not severe complications（such as angiorrhexis,perforation） during interventional procedure.No clinical manifestation of pulmonary embolism emerged after operations.During follow-up,13 patients died of tumor aggravation,3 patients suffered the symptoms of venous occlusion again.The blood flow of veins treated still kept fluent confirmed by Doppler ultrasonography in other 31 patients.Conclusion Interventional therapy has advantages of smaller injures,well tolerance,high successful rate,quick palliation of symptoms and good clinical efficacy in the treatment for venous vascular complications of malignant tumor.

关 键 词：肿瘤 静脉 支架 

分 类 号：R730.5[医药卫生—肿瘤]