上腔静脉综合征的外科治疗

Surgical treatment of superior vena cava syndrome

目的总结上腔静脉综合征（SVCS）的外科治疗经验。方法回顾性分析手术治疗的26例SVCS患者（男19例，女7例，年龄19～63岁）的临床资料，包括临床表现、术前检查、手术方法、术后病理诊断和生存时间。病例纳入标准为影像学检查提示纵隔占位以及上腔静脉和（或）无名静脉部分或完全梗阻，无其他部位肿瘤，纵隔病变经组织病理学检查无明确淋巴瘤的证据。结果常见临床表现为颜面及颈部发绀、水肿，颈部及胸壁静脉曲张，头晕，头痛，咳嗽，呼吸困难。术前CT引导下穿刺活检，6例明确诊断胸腺恶性肿瘤，20例无法明确诊断。行原发病灶切除和上腔静脉人工血管置换术，20例患者获得根治性完全切除，6例因病变侵犯广泛行肿物大部分切除。术后中位生存期完全切除者为30个月，不完全切除者为11个月（P=0．0036）；全组病例1年生存率为69．2％，5年生存率为7．6％。结论手术切除方式是影响SVCS患者预后的重要因素。

Objective To analyze the clinical features, especially surgical treatment of superior vena cava syndrome （SVCS）. Methods The clinical data of 26 patients with SVCS, 19 males and 7 females, aged 37 （19 -63 ）, diagnosed base on the space occupying lesion in mediastinum and complete or incomplete obstruction of SVC and/or innominate vein by imaging examination without evidence of tumor in other parts and without evidence of lymphoma in the mediastinal lesion by pathological examination, who underwent surgical treatment were analyzed, focusing on the clinical presentation, preoperative examination, surgical treatment, pathological diagnosis, and survival. Results Facial cyanosis and edema, cervical and chest wall varicose veins, headache and dizziness, cough and dyspnea were the most common clinical manifestations. Pre-operative percutaneous needle biopsy guided by CT confirmed the diagnoses of malignant tumor of mediastinum in 6 cases and definite diagnoses failed to be got in the other 20 cases. Resection of the primary lesions combined with artificial blood vessel replacement of SVC was performed. Twenty patients received complete resection, and 6 received only incomplete excision because of extensiveness of lesions. The mean survival time of the former group was 30 months, significantly longer than that of the latter group （11 months, P = 0. 0036）. The overall 1-year survival rate was 69.2%, and 5-year survival rate was 7.6%. Conclusion Resection procedure is an important factor influencing the prognosis of SVCS.