胸部肿瘤侵及上腔静脉的外科治疗

Surgical treatment for patients with chest cancers invading the superior vena cava

目的 总结胸部肿瘤侵及上腔静脉（SVC）患者的临床治疗经验.方法 回顾性分析12例胸部肿瘤侵及SVC患者的临床资料,3例通过人工血管置换SVC及无名静脉,其余9例行血管直接缝合或自体心包补片修补SVC.结果 本组10例获得完全性切除,2例不完全性切除.围手术期无死亡.全组病例随访1～7年,有3例失访,余下9例中5例因肿瘤复发或转移死亡,中位生存时间8个月,另4例均生存,中位生存时间42个月.结论 胸部肿瘤侵犯SVC应力争手术治疗,切除肿瘤同时行SVC的重建,预后较保守治疗效果好.患者术后生活质量提高,生存期延长.

Objective To summarize the experiences in clinical diagnosis and surgical treatment of chest cancers invading the superior vena cava （SVC）. Method Retrospective study of 12 cases with chest cancers invading the SVC, SVC and innominate vein were reconstructed with prosthesis in 3 cases, the side wall of the SVC was excised and repaired in 9 cases. Results Complete resection was performed in 10cases,2 cases had incomplete resection. There was no death associated with operation in these patients. All patients were followed up for 1 - 7 years after operation,and 3 cases were lost to follow up,5 of remaining 9cases were dead because of relapse and metastasis, their median survival time was 8 months,other 4 cases lived, their median survival time was 42 months. Conclusions Patients with chest cancers invading the SVC should have surgical treatment of not only tumor resection but also the vessel reconstruction,the prognosis would be better than without surgical treatment. These patients have a high quality of life and live with long-term survival.