恶性腔静脉梗阻的介入综合治疗

Combined interventional therapy for malignant vena cava obstruction

目的 探讨溶栓、球囊扩张和支架置入相结合治疗恶性腔静脉梗阻的临床应用价值。方法 对8例上腔静脉梗阻,21例下腔静脉梗阻分别采用球囊扩张联合支架置入（腔静脉完全梗阻和支架扩张不满意患者）、支架置入（腔静脉不完全梗阻患者）,并结合溶栓治疗（腔静脉梗阻合并血栓形成患者）。结果 共置入支架29枚,支架释放成功率100%。8例上腔静脉梗阻术后症状完全消退。21例下腔静脉梗阻分级评分由术前4～5分（平均4.2分）降为术后0～2分（平均0.3分）,术前后差异有显著性意义（Z=-55.245,P=0.000）。29例随访1～20个月,平均6.2月,腔静脉通畅。1例发生腔静脉撕裂、1例术后第3天出现支架移位至右心房,其余27例术后无严重并发症发生。结论 溶栓、球囊扩张和支架置入相结合是治疗腔静脉梗阻安全、有效的方法。

Objective To evaluate the effectiveness of combined treatment with thrombolysis, PTA, and endovascular stent placement for malignant obstruction of vena tara, Methods The study included 29 patients with malignant obstruction of vena cava （superior, 8 patients; inferior, 21 patients）. The patients underwent treatment of PTA and endovascular stent placement （for patients with complete vena cava obstruction or patients with incompletely expanding stent） , or endovascular stent placement （for patients with incomplete vena cava obstruction） , or endovascular stenting combined with thrombolysis （for patients with thrombosis in vena cava） , respectively. Results A total of 29 stents was implanted, with a success rate of stent placement of 100%. Symptoms of SVC obstruction completely disappeared in the 8 patients. Scores of patients＇ IVC syndrome were declined from 4 ～ 5 （ median, 4.2） preoperatively to 0 ～ 2 （ median, 0.3 ） postoperatively, with statistically significant difference （ Z = - 55. 245, P = 0. 000）. Follow-up checkups for 1 ～ 20 months （ mean, 6.2 months） in the 29 patients found patent vena cava. There were no serious complications except for vena cava laceration in 1 patient and stent displacing to the right atrium on the third day after therapy in 1 patient. Conclusions The combined treatment of thrombolysis, PTA, and endovascular stenting is safe and effective in the treatment of vena cava obstruction.