[1]宋磊,王峰①,纪东华*①,等.恶性肿瘤所致上腔静脉压迫综合征的介入治疗[J].中国微创外科杂志,2008,08(4):355-359.
　Song Lei*,Wang Feng,Ji Donghua,et al.Interventional Treatment for Superior Vena Cava Syndrome with Malignant Causes[J].Chinese Journal of Minimally Invasive Surgery,2008,08(4):355-359.
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恶性肿瘤所致上腔静脉压迫综合征的介入治疗()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年4期
页码:
355-359
栏目:
出版日期:
2008-10-26

文章信息/Info

Title:
Interventional Treatment for Superior Vena Cava Syndrome with Malignant Causes
作者:
宋磊; 王峰①; 纪东华*①; 张弦
大连医科大学附属第二医院肿瘤科，大连116023
Author(s):
Song Lei*;  Wang Feng;  Ji Donghua;  et al.
*Department of Oncology, Second Affiliated Hospital of Dalian Medical University, Dalian 116023, China
关键词:
上腔静脉综合征; 恶性肿瘤; 内支架; 溶栓治疗
Keywords:
Superior vena cava syndrome; Malignant tumor; Intravascular stent; Thrombolysis
分类号:
R73；R543
文献标志码:
A
摘要:
目的探讨采用介入方法治疗恶性肿瘤所致上腔静脉阻塞综合征的疗效及临床意义。方法13例恶性肿瘤所致上腔静脉阻塞综合征患者中,肺癌伴纵隔淋巴结转移8例,食管癌纵隔淋巴结转移2例，纵隔恶性肿瘤2例,乳腺癌纵隔淋巴结转移1例，均经原发灶病理证实为恶性。经右侧股静脉入路，以猪尾巴导管于狭窄段近端或远端造影，明确狭窄部位、长度、程度，无局部血栓形成者直接置入Wallstent支架（Boston Scientific，USA），1例同时置入Z形支架（COOK，USA），合并血栓病例留置溶栓导管局部溶栓后再置入支架。结果13例全部开通成功,手术成功率100％，狭窄段平均长度4.3 cm（3～6 cm）。1例置入2枚支架，其余患者均置入1枚支架。6例在支架置入前行溶栓治疗。开通前后梗阻远侧卧位测静脉压,术前(26.2±1.6) cm H2O，术后降至(4.3±0.8) cm H2O，置入支架后造影示侧支静脉完全消失,上腔静脉阻塞症状于术后即刻至术后3 d完全消退。8例术后4～10个月内死于肿瘤多处转移造成脏器功能衰竭,其余5例（包括后续治疗的3例）存活，随访8~26个月，中位数13个月，所有病例上腔静脉阻塞症状未再复发。结论上腔静脉支架置入部分联合导管局部溶栓治疗是恶性肿瘤所致上腔静脉阻塞综合征有效的微创治疗方法。
Abstract:
ObjectiveTo evaluate the efficacy and clinical value of percutaneous transluminal angioplasty (PTA) with stenting for the treatment of superior vana cava syndrome (SVCS) with malignant causes.MethodsA total of 13 patients with SVCS with malignant causes were enrolled in this study. Among the patients, 2 had mediastinal cancer,and 11 had metastatic mediastinal tumor. The malignancy of the primary tumors of the 11 patients, including pulmonary cancer in 8, esophageal cancer in 2, and breast cancer in 1, were all confirmed by pathological examination. Via the right femoral vein, a pigtail catheter was introduced percutaneously into the proximate or remote end of the stenotic segment for the visualization of the SVC. After the location, length, and gravity of the stenosis were determined, Wallstent (Boston Scientific, USA) was placed into the SCV, if the patients had no local thrombosis in the stenotic segment. In one patient, a Zshape stent (COOK, USA) was inserted simultaneously. For the cases complicated with thrombosis, the Wallstent was inserted after local thrombolysis.ResultsThe procedure was completed in all the 13 patients with a success rate of 100%. The average length of the stenotic segment was 4.3 cm (3-6 cm). In one patient, two stents were used, while in the others only one stent was inserted. Thrombolysis was carried out before stenting in 6 patients. The intravenous pressure at the proximate end of the stenotic segment was determined with the patients supine before and after stenting.The pressure decreased from (26.2±1.6) cm H2O to (4.3±0.8) cm H2O after the operation. Postoperative angiography showed no collateral vein in the patients. The SCVS disappeared 0 to 3 days after the surgery. The patients were followed up for 8-26 months with a median of 13. During this period, 8 patients died of multiple organ failure caused by multiple metastasis of the primary tumor in 4 to 10 months; the other 5 patients survived (3 of them received further therapies) without recurrence of SCVS. ConclusionPTA with stenting combined with local thrombosis is an effective and invasive treatment for patients with SCVS with malignant causes.

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备注/Memo

备注/Memo:
①（大连医科大学附属第一医院介入科，大连116020）*通讯作者
更新日期/Last Update: 2013-10-22