应用腔静脉Z型支架治疗上腔静脉阻塞综合征

Treatment of superior vena cava obstructive syndromes by vena cava Z-type stent

目的：评价国产腔静脉Z型支架治疗肺癌所致上腔静脉阻塞综合征的临床价值。方法：本组19例肺癌患者中，右肺上叶病变直接导致上腔静脉阻塞12例，纵隔淋巴结转移导致上腔静脉阻塞7例。右股静脉入路，将导管送入狭窄段远端并行DSA检查，测量狭窄段的长度和正常上腔静脉的直径。理想的支架直径应大于正常上腔静脉直径10％，支架长度应越过狭窄段两端1～2cm。术后应用透视或胸片观察支架位置，Doppler随访支架开通情况。结果：放置支架成功后，造影显示对比剂顺利通过开通的支架内，侧枝循环消失，平均上腔静脉压力由术前的27．3±8．4cmH2O降为14．2±3．7cmH2O，支架放置前后对比差异有显著性意义。结论：应用国产腔静脉Z型支架治疗肺癌伴上腔静脉阻塞综合征是微创、有效的治疗方法。

Objective：To study the clinical value of using local intravascular Z-type stent for superior vena cava syndrome （SVCS） in 19 patients with primary pulmonary carcinoma. Methods： Among 19 primary pulmonary carcinoma patients with SVCS, 12 cases were caused by the tumors in right upper lobe, 7 eases by mediastinal lymphnode metastases. By route of right femoral vein, SVCS catheterization and DSA was made. The length of the strictures and the diameters of normal superior vena eava were measured for the choice of appropriate stents. The option of stent diameter is 10% larger than that of normal SVCS. The upper and lower ends of the stent should be 1 - 2cm protruding from the ends of the stricture. Stems were observed about their positions by fluoroscopy or chest films, and about patency of superior vena cava （SVC） by Doppler. Results： After the placement of a stent, DSA revealed the contrast media in the SVC passed along smoothly, collateral branches diminished remarkably. Average SVC pressure was decreased from 27.3 ± 8.4cm H2O before the placement down to 14.2±3.7cmH2O,with significance statistic difference （ P 〈 0.01）. Related clinical symptoms and signs disappeared or relieved. Condusion：The therapy of local intravascular Z-type stent to treat SVCS is mieroinvasive and effective.