应用生物材料重建上腔静脉

Superior Vena Cava Reconstruction Using Biomaterials

目的:探讨胸部肿瘤手术中上腔静脉及其属支切除后生物材料重建上腔静脉的方法和效果。方法:2003年5月到2005年12月,11例累及上腔静脉及其属支的胸部肿瘤病人使用牛颈静脉或自体心包重建上腔静脉。手术置换血管前后中心静脉压予以连续测定,并随访病人治疗结果。结果:重建生物血管12根,其中牛颈静脉7根,自体心包缝制管道5根,一例同时应用了牛颈静脉与自体心包管道。手术前中心静脉压偏高[(26．2±2．8)cmH_2O,n=11],手术重建上腔静脉后略有降低[(20．8±2．0)cmH_2O,与手术前比较,P＜0．05],手术后48小时已经降低到接近正常范围[(13．5±1．9)cmH_2O,与手术前比较,P＜0．05]。手术中无死亡,1例术后发生肺部感染最后致呼吸衰竭,5周后死亡,其余病人均度过围手术期。2例分别于术后7个月和11个月死于原发肿瘤复发,一例术后一年发现有脊柱转移,目前带瘤生存,余7例病人目前无复发迹象。结论:牛颈静脉或自体心包可以作为一种可以接受的上腔静脉重建替换材料。

Objective： To evaluate the methods and effects of reconstructing superior vena cava （SVC） using biomaterials after resection of SVC and its branches in patients with malignant mediastinal or pulmonary tumors through anterior mediastinotomy. Patients and Methods： From May in 2003 to December in 2005, 11 cases of patients with SVC obstruction underwent SVC reconstruction using bovine jugular vein conduits （BJVCs） or autologopus pericardial tubes, the central venous pressures （CVPs） were detected continuously before and after replacing the SVC, and the therapeutic results were followed up. Results： Of 12 biomaterial conduits used in 11 patients, 7 were BJVCs, and 5 were autologopus pericardial tubes. One patients used both of the two conduits. The CVPs were increased berore operation [（26.2±2.8）cmH2O], decreased after reconstruction [（20.8±2.0）cmH2O, compared with before operation, P〈0.05], and decreased all the more 48 hours after operation [（ 13.5±1.9 ）cmH2O, compared with before operation, P〈0.05 ]. All patients survived operation and the grafts were patent without signs of obstruction after operation. One died in 5 weeks after operation because of respirative failure ; two of them died of recurrence from primary carcinoma 7 and 11 months after operation;the others have been alive and remains free from signs and symptoms of SVC obstruction except that metastasis was found in vertebrae in one patients. Conclusions： The initial result supports autologopus pericardial tube or BJVC as an acceptable alternative for SVC reconstruction.