肿瘤所致下腔静脉狭窄及阻塞的介入性开通治疗

The interventional therapy in inferior vena cava stenosis or obstruction caused by carcinoma

目的 探讨肿瘤所致下腔静脉狭窄及阻塞的介入性开通治疗的疗效及术后处理。方法5 3例肿瘤性下腔静脉狭窄病人 ,有完整随访资料。先用导丝通过狭窄段或潜在的缝隙行球囊扩张后 ,置入支架 ,造影并测量下腔静脉压。结果 5 3例中 5 0例开通成功 ,3例因导丝无法通过完全阻塞的下腔静脉而失败。 2例因狭窄段超过 10cm而置入 2个支架 ,其余病人均置入 1个支架。开通后下腔静脉压由术前 (2 8 6 6± 4 0 8)cmH2 O (1cmH2 O =0 0 98kPa)降至 (17 6 5± 4 18)cmH2 O ,经t检验 ,开通前后下腔静脉压变化具有非常显著性差异 (t=3 2 6 1,P <0 0 1)。 5 0例置入支架的病例中 48例下腔静脉狭窄或阻塞所致的临床症状及体征在 3～ 5d内消失或部分消失。 1例术中发生肺梗死 ,未出现其他严重并发症 ,平均随访 13 5个月 ,46例仍保持通畅。

Objective To investgate the value of interventional therapy in inferior vena cava stenosis or obstruction caused by tumor and management after the operation. Methods 53 patients with IVC stenosis caused by tumor had detailed information. After the guide wire passed through the stenosised part and then undergoing balloon expansion, Gianturco Z stents or wallstents were implanted to undergo venography and measuring pressure after that. Results Technical success was attained in 50 patients, 3 cases was failure because the guide wire couldn't pass through the obstructed region.The technical success rate is 94.3%. 2 patients with IVC stenosis over 10 cm length was placed two stents. In other 48 patients,everyone was placed one stent. The pressure of IVC dropped from (28.66±4.08)cm H 2O (1 cm H 2O =0.098 kPa) before operation to (17.65±4.18)cm H 2O after operation. Through t examination, the difference of IVC pressure before and after treatment has statistic significance( t =3.261, P <0.01). After operation,the main symptoms and physical signs caused by tumor relieved quickly in 3-5 days in 48 cases. Total effective rate was 96% except one patient accompanied by pulmonary infarction in operation. The serious complications were not encounted during and after the operation. Conclusion Stents placement are safe and reliable procedures for treating IVC stenosis.