上腔静脉综合征的诊断与外科治疗  

Diagnosis and Surgical Treatment of Superior Vena Cava Syndrome

作　　者：武玉兵[1] 张京楠[1] 孙毅[1] 

机构地区：[1]山东省临沂市沂水中心医院,山东沂水276400

出　　处：《中国医学创新》2012年第22期20-22,共3页Medical Innovation of China

摘　　要：目的:探讨上腔静脉综合征(superior vena cava syndrome,SVCS)的外科诊疗经验,提高手术成功率。方法:上腔静脉综合征病例7例,手术切口采用右胸后外侧切口4例,胸骨正中切口3例。行根治性右全肺切除加上腔静脉(SVC)置换术3例,姑息性右肺上叶切除加左无名静脉与右心耳旁路搭桥术1例,纵隔肿瘤部分切除加左无名静脉与右心耳旁路搭桥术2例,纵隔炎性病变行左无名静脉与右心耳旁路搭桥术1例。5例采用绦纶人造血管,2例采用螺旋形的自体大隐静脉。结果:本组无手术死亡及严重手术并发症。通过采取SVC置换术、左无名静脉与右心耳旁路搭桥术,平均压由术前28.4cmH2O降至术后的9.5cmH2O。患者SVCS症状一般在3d内消失。凡良性疾病引起的上腔静脉阻塞均得到根治,恶性肿瘤所致上腔静脉阻塞手术后改善了患者生存质量。结论:任何疾病所致上腔静脉阻塞,选择性采取手术治疗是必要的。尽量缩短上腔静脉阻断时间,以减轻对脑组织的损害。在人工血管置换时,可采用先吻合近心端的方法,即将肿瘤游离后不切断上腔静脉,先完成人工血管与右心耳的吻合后,再阻断SVC,切除肿瘤,最后行人工血管与SVC远端的端端吻合,这样可显著缩短上腔静脉阻断时间,可有效预防脑组织损害。Objective：To summarize the surgical experience of the diagnosis and treatment of 7 patients with superior vena cava syndrome （SVCS）, improve the success rate of operation.Method：7 cases of SVCS underwent surgical treatments, 4 cases with the right chest after of lateral incision, 3 cases with the median sternotomy incision.3 cases with radical right lung resection and SVC replacement, 1 case with palliative resection of the right lung on the left and right atrial appendage unknown vein bypass surgery, mediastinal tumor resection of the left and right atrial appendage unknown vein bypass in 2 case, 1 case with mediastinal inflammatory disease of unknown left and right atrial appendage bypass vein bypass surgery. five cases continued use of artificial blood vessels, two cases of using spiral of self-saphenous vein.Result：There was no operative death and serious complications.Through SVC replacement, left and right atrial appendage unknown vein bypass surgery, the average pressure of SVC was decreased from 28.4 cm H2O preoperative to 9.5 cm H2O after operation. The symptoms of SVCS patients were disappeared generaUy within three days.the superior vena cava obstruction caused by benign disease had been radically improved, that caused by malignant tumors had been improved the quality of life after surgery.Concluslon：To take selective treatment is necessary for the superior vena cava obstruction caused by any disease.Redued the blocking time of the superior vena cava can be effective in preventing brain damage.Author＇ s experience in the replacement of artificial blood vessels, anastomosis of nearly heart-first and the superior vena cava is operted before the tumor is cut off, the anastomosis of the first complete artificial vascular and the right atrial appendage is first operted, and then blocked SVC, tumor resection, the distal end-to-end anastomosis of line Artificial blood vessels and SVC is the last operated, thouththismetbod, theblockingtimeofthesuperiorvenacavacanbesignificantlyshorten.

关 键 词：上腔静脉综合征 诊断 外科治疗 

分 类 号：R734[医药卫生—肿瘤]