肺癌合并上腔静脉综合征的介入治疗  

Interventlonal therapy for lung cancer patients with superior vena cava syndrome

作　　者：罗洁[1] 陈斌[1] 江森[2] 周崧雯[1] 

机构地区：[1]同济大学附属上海市肺科医院肿瘤科,200433 [2]同济大学附属上海市肺科医院放射科

出　　处：《中华肿瘤杂志》2013年第8期627-631,共5页Chinese Journal of Oncology

摘　　要：目的探讨肺癌合并上腔静脉综合征实行介入治疗的方法、疗效及安全性。方法52例肺癌合并上腔静脉综合征（SVCS）患者接受血管腔内成形及支架置人术治疗，治疗前后测量血管梗阻远端静脉压力。对50例接受肺癌综合治疗的患者进行疗效评价。结果有50例患者成功置人血管内支架。血管梗阻远端静脉压力检测显示，术前血管梗阻远端静脉压力为（28．2±1．9）cmH2O，术后血管梗阻远端静脉压力为（8．7±0．5）cmH2O，差异有统计学意义（P=0．0085）。血管腔内成形及支架置入术后，完全改善20例，部分改善28例，无效4例，总有效率92．3％。血管腔内成形及支架置入术后出现胸痛12例（23．1％），穿刺部位血肿5例（9．6％），发热2例（3．8％），无大出血、肺栓塞和支架移位进入心房等严重并发症。小细胞肺癌患者的客观有效率和1年生存率分别为74．1％和21．0％，非小细胞肺癌患者的客观有效率和1年生存率分别为21．7％和35．0％。结论血管腔内成形及支架置人术可作为肺癌合并SVCS患者的首选治疗。但血管腔内成形及支架置人术仅仅是一种姑息性的治疗手段，在支架置人后继续针对肿瘤的治疗十分必要。Objective To investigate the method, therapeutic effect and safety of interventional therapy for lung cancer patients with superior vena cava syndrome （SVCS）. Methods Fifty-two cases of lung cancer with SVCS who received interventional therapy in our hospital between Jan to Dec 2011 were included in this study. Of the 52 cases, 50 cases had successfully carried out superior vena cava stent implantation. The distal venous pressure was measured before and after angioplasty, and the results were assessed by Wilcoxon matched-pairs test. In addition, the 50 patients were followed up and the therapeutic effect and postoperative survival rate were evaluated. Results The mean distal venous pressure in the 50 patients was significantly decreased from preoperative （28.2 ± 1.9）cm H20 to postoperative （8.7±0.5 ） cm H20 （P = 0. 0085 ）. The efficacy of the treatment was as follows： complete remission （20/52, 38.5% ）, partial remission （28/52, 53.8% ）, ineffective 4 （4/52, 7.7% ）, and total effective rate 92.3%. The complications after angioplasty and stent implantation included chest pain （ 12 cases, 23.1% ）, hematoma at the puncture site （5 cases, 9.6% ）, and fever （2 cases, 3.8% ）. No serious complications such as massive hemorrhage, pulmonary embolism and stent migration into the cardiac atrium were observed. The rate of postoperative restenosis was low （2/52, 3. 8% ）. For the SCLC group, the objective effective rate was 74.1% and 1-year survival rate was 21.0%. For the NSCLC group, the objective effective rate was 21.7% and 1-year survival rate was 35.0%. Conclusions For lung cancer patients with SVCS, interventional therapy may relief obstruction effectively, promote blood flow recovery, and relieve clinical symptoms. Interventional therapy with endovaseular angioplasty and stenting may be highly recommended as the first choice for palliative treatment of SVCS. It is an effective initial palliative treatment. However, subsequent comprehensive anti-tumor treatment is necessar

关 键 词：肺肿瘤 上腔静脉综合征 介入治疗 治疗效果 

分 类 号：R734.2[医药卫生—肿瘤]