恶性肿瘤所致上腔静脉压迫综合征的介入治疗

In terventional Treatment for Superior Vena Cava Syndrome with Malignant Causes

目的:探讨采用介入方法治疗恶性肿瘤所致上腔静脉阻塞综合征(SVCS)的疗效及临床意义。方法:24例上腔静脉阻塞综合征患者,经右侧股静脉入路,以猪尾巴导管于狭窄段近端或远端造影,明确狭窄部位、长度、程度,无局部血栓形成者直接置入Wallstent支架(Boston Scientific,USA),合并血栓病例留置溶栓导管局部溶栓后再置入支架。结果:24例全部开通成功,手术成功率100%,狭窄段平均长度4.6 cm(3～7 cm)。3例置入2枚支架,其余患者均置入1枚支架。9例在支架置入前行溶栓治疗。开通前后梗阻远侧卧位测静脉压,术前(27.3±1.8)cmH2O,术后降至(4.5±0.8)cmH2O,置入支架后造影示侧支静脉完全消失,上腔静脉阻塞症状于术后即刻至术后3 d完全消退。随访8～26个月,11例术后5～10个月内死亡,13例存活,所有病例上腔静脉阻塞症状未再复发。结论:上腔静脉支架置入术联合导管局部溶栓是治疗恶性肿瘤所致上腔静脉阻塞综合征有效的微创治疗方法。

Objective：To explor the use of interventional methods in the treatment of malignant tumor with superior vena cava obstruction syndrome（SVCS） efficacy and clinical significance.Methods：A total of 24 patients with SVCS with malignant causes were enrolled in this study were all confirmed by pathological examination.Via the right femoral vein,a pigtail catheter was introduced percutaneously into the proximate or remote end of the stenotic segment for the visualization of the S VC.After the location,length,and gravity of the steno sis were determined,Wallstent（Bost on Scientific,US A） was placed into the SCV,if the patients had no local thrombosis in the stenotic segment.For the cases complicated with thrombosis,the Wallstent was inserted after local thrombolysis.Results：The procedure was completed in all the 24 patients with a success rate of 100%.The average length of the stenotic segment was 4.6 cm（3~7 cm）.In three patients,two stents were used,while in the others only one stent was inserted.Thrombolysis was carried out before stenting in 9 patients.The intravenous pressure at the proximate end of the stenotic segment was determined with the patients supine before and after stenting.The pressure decreased from（27.3±1.8）cmH2O to（4.5±0.8）cmH2O after the operation.Postoperative angiography showed no collateral vein in the patients.The SCVS disappeared 0 to 3 days after the surgery.The patients were followed up for 8~26 months.During this period,11 patients died in 5 to 10 months;the other 13 patients survived without recurrence of SCVS.Conclusions：Superior vena cava stenting combined with catheter directed thrombolysis is an effective and invasive treatment for patients with SCVS with malignant causes.