支架联合植入放射性粒子治疗上腔静脉综合征  

Treatment of superior vena cava syndrome with stent and radioactive seeds implantation

作　　者：林连城 曾俊莉 邓伟先 柯明耀 Lin Liancheng;Zeng Junli;DengWeixian;Ke Mingyao(Department of Respiratory Oncology,Second Affiliated Hospital of Xiamen Medical College,Xiamen,Fujian 361021China)

机构地区：[1]厦门医学院附属第二医院呼吸病医院呼吸肿瘤科

出　　处：《当代医学》2019年第24期113-115,共3页Contemporary Medicine

摘　　要：目的探讨经皮上腔静脉支架置入联合经皮碘125放射性粒子植入术治疗上腔静脉压迫综合征的可行性及疗效。方法收集肺癌合并上腔静脉阻塞综合征患者共8例。经右侧股静脉入路上腔静脉造影,了解狭窄情况、血栓形成与否,测量狭窄两端压力,并于狭窄处置入血管支架。支架置入后1周内CT引导下经皮肺穿刺于上腔静脉周围植入碘125放射性粒子,125I活度0.7 mCi,每例植入25~30枚粒子。结果8例患者均一次性成功置入一枚上腔静脉支架,支架植入后造影显示血流恢复通畅,侧支循环明显减少、消失;术前狭窄远端压力30~44 cmH2O,平均(38.00±4.95)cmH2O,术后压力17~37 cmH2O,平均(30.50±8.06)cmH2O,术后上腔静脉压力较术前显著下降(P=0.042);术后的近端压力亦较前明显降低(P=0.042)。粒子植入后随访3~9个月,疗效评价:PR7例,SD1例。结论经皮上腔静脉血管支架置入术是一种创伤小、恢复快、疗效肯定的姑息治疗方法,并为后续的抗肿瘤治疗赢得时间及机会;联合经皮穿刺碘125放射性粒子植入术能有效、持续地控制肿瘤进展,是治疗上腔静脉阻塞综合征的有效方法。Objective To explore the efficacy and feasibility of percutaneous intravascular stents placement combined with 125I seed implantations for superior vena cava obstruction syndrome(SVCOS).Methods Our research included eight lung cancer with SVCOS patients.We conducted phlebography of the superior vena cava through the right femoral vein to investigate the stenosis and thrombogenesis,measure the pressure of proximal and distal end of stenosis,and to place the stent into the stenosis site.In 1 week after stent placement,125I seed was implanted around superior vena cava by CT guided percutaneous transthoracic biopsy.The activity of 125I seed was 0.7 mC,25-30 125I seed was implanted in one case.Results The stent were successfully implanted in all the eight patients.Phlebography revealed that blood stream were restored,collateral circulation were reduced or disappeared.The pressure of proximal end of stenosis was 30-44 cmH2O,average(30.50±8.06)cmH2O before operation,and 17-37 cmH2O,average(30.50±8.06)cmH2O after operation.The pressure of distal end of stenosis was also significantly dropped after operation(P=0.042).The followup time was 3 to 9 month after 125I seed were implanted.seven patients received PR and one received SD.Conclusion Percutaneous intravascular stents placement in SVCOS was a effective therapy,which recover quickly with minimal trauma.Besides,it provided the chance for subsequent antitumor therapy.Combined with 125I seed implantations could control tumor progression persistently.

关 键 词：上腔静脉综合征 肺癌 内支架 碘125放射性粒子 

分 类 号：R47[医药卫生—护理学]