内支架联合局部定向溶栓治疗上腔静脉综合征

Treatment of superior vena cava syndrome in cancer patients with intravascular stent and local thrombolysis

目的 探讨内支架联合导管定向溶栓治疗肿瘤性上腔静脉阻塞综合征的方法及意义。方法 2 6例肿瘤性上腔静脉阻塞综合征患者中 ,肺癌伴纵隔淋巴结转移 17例 ,纵隔恶性肿瘤 5例 ,食管癌纵隔淋巴结转移 2例 ,非霍奇金淋巴瘤 2例。采取股静脉入路 ,将多侧孔导管送至上腔静脉阻塞段血栓内 ,经导管滴注尿激酶 ,时间为 2 0～ 40min。然后球囊扩张 ,植入自张式支架。结果 2 4例开通成功 ,2例因闭塞导丝无法通过而失败。 2 4例中有 3例患者狭窄段长 10cm ,置入 2个支架 ;余 2 1例均置入一个支架。 2 4例在扩张前均行溶栓治疗。开通前后梗阻远侧测静脉压 ,从术前的 2 1.2 3± 1.80mmHg降到术后的 5 .33± 0 .98mmHg(患者均为卧位测压 )。经统计学处理 ,开通前后梗阻远侧静脉压力变化差异有显著性 (P <0 .0 1)。开通后造影示侧支静脉均不再显影 ,上腔静脉管径接近正常 ,轮廓光整。上腔静脉阻塞症状于术后 2～ 3d消退。结论 经股静脉入路 。

Objective To study the therapentic efficacy of using intravascular stent and local thrombolysis for superior vena cava syndrome(SVCS) in cancer patients. Methods Among 26 cancer patients with SVCS there were 17 cases of lung cancer with mediastinal lymphnode metastases, 5 cases of malignant mediastinal tumor, 2 cases of non Hodgkin′s lymphomas, 2 cases of esophageal carcinoma with mediastinal lymphnode metastases. Through femoral vein, a catheter with side holes was introduced up to the superior vena cava. Following local dripping of urokinase for 20 40 min, the obstructed region was distended with the inflated balloon and then a self expanding stent was put in the inflated region.Results The procedure was successful in 24 patients, but failed in 2 cases because the guide wire could not pass through the obstructed region. In 3 patients with superior vena cava stenosis of 10 cm in length, two stents were used. In the other 21 patients, 1 stent was adequate. Local thrombolytic treatment was given in 24 patients before the angioplastic balloon was inflated. The vena caval pressure at the distal end of the stenotic lesion dropped from 21.23±1.80 mm Hg before treatment to 5.33±0.98 mm Hg after treatment. The difference was statistically significant. Collateral veins were no longer filled by contrast after treatment . The caliber of the supericar vena cava restored to normal and its outline was smooth. The symptoms of SVCS subsided after treatment in 2 3 days.Conclusion Intravascular, self expandable stent combined with local thrombolysis is a micro invasive and effective method of treatment for cancer patients with superior vena cava syndrome.