人工血管置换上腔静脉及其分支在胸腔肿瘤中的应用

Replacement of superior vena cava and its branches by artificial vessels in the treatment of chest tumor

目的总结12例胸腔肿瘤侵犯上腔静脉及其分支时人工血管置换手术的处理经验,分析上腔静脉及其分支人工血管置换手术的技术方法及临床意义。方法回顾性分析12例上腔静脉及其分支受到肿瘤侵犯患者的手术经验。受侵血管包括上腔静脉和(或)左右无名静脉。结果 12例患者接受了不同类型的上腔静脉置换手术,包括左及右无名静脉分别与右心房人工血管搭桥术6例、左无名静脉与右心房人工血管搭桥2例、右无名静脉与右心房搭桥1例、右无名静脉与上腔静脉搭桥1例,单纯上腔静脉置换术2例。上腔静脉及其分支置换均应用Gore-Tex人工血管,共应用人工血管18支,直径8～16 mm。所有手术均成功进行,无手术死亡,无严重并发症。术后生存时间最长者达5年,1例良性畸胎瘤患者。结论人工血管置换上腔静脉及其分支手术,是根治性切除侵犯上腔静脉系统胸腔肿瘤的关键性技术,正确及时地应用可以提高根治性切除率,消除上腔静脉综合征,提高患者的生存质量及生存率。

Objective Retrospective analysis of the results,techniques and indications for replacement of superior vena cava（SVC） and its branches by artificial graft in surgical treatment of 12 chest tumor patients. Methods Twelve patients with SVC and/or innominate veins being invaded by tumors were included and analyzed retrospectively in this study. Results Six patients were subjected to two bypasses（between left and right innominate veins and right appendage）; four patients had one bypass（left innominate to right appendage in 2 patients,right innominate to right appendage in 2 patients）; two patients had partial resection of SVC together with azygous vein. Eighteen Gore-Tex artificial vessels with 8-16 mm in diameters were used for SVC replacement or bypass in all patients. One patient with teratomas treated by SVC surgery had so far the longest survivor time of 5 years. Conclusion Replacement of SVC and its branches by artificial vessels are the key technique to completely removing chest tumor cells invading SVC and its branches. Its reasonable and timely use can improve the rate of complete resection,alleviate the SVC syndrome and increase the survival rate and quality.