对吻式支架置入术在双头臂静脉-上腔静脉梗阻中的应用价值

Application value of kissing stenting for the treatment of bilateral brachiocephalic-superior vena cava obstruction

目的 评价对吻式支架置入术治疗双头臂静脉-上腔静脉梗阻的应用价值.方法 回顾性分析17例恶性肿瘤所致的双侧头臂静脉-上腔静脉梗阻患者的临床资料.17例均有不同程度双侧头臂静脉-上腔静脉梗阻的症状和体征.所有患者均采用2枚适宜规格的支架行对吻式置入头臂静脉-上腔静脉,其中1例伴静脉血栓形成,先行导管局部溶栓治疗后再行支架置入治疗.术后观察患者的症状改善情况和并发症,并随访观察患者是否复发.结果 17例均成功完成支架置入术.术后患者症状、体征均明显好转或消失.无严重并发症发生.17例随访1 ～16个月,包括5例因恶性肿瘤终末期死亡的患者在内,均未再出现静脉梗阻症状.结论 支架对吻技术可能是治疗恶性肿瘤所致双头臂静脉-上腔静脉梗阻安全、有效的方法.

Objective To evaluate the clinical value of the kissing stenting in bilateral brachiocephalic-superior vena cava obstruction syndrome.Methods Analysis the clinic effect in 17 patients who received interventional treatment retrospectively.All patients with bilateral brachiocephalic vein-superior vena cava obstruction were caused by malignant tumor.Each patient was implanted two stents by kissing stenting style.Among them,1 patient accompanied thrombosis in brachiocephalic vein was conducted with catheter-directed thrombolysis before stenting.The symptoms,pathological signs and complications were observed after the treatment,patients were underwent follow-up to see whether symptom recurred.Results All 17 patients received successful kissing stenting in bilateral brachiocephalic vein-superior vena cava.The symptoms and pathological signs eliminated after the operation.No serious complications occurred.Seventeen patients were underwent follow-up （1 to 16 months） with no obstructive symptom recurred including 5 patients died of the end-stage of malignant tumor.Conclusion Kissing stenting is a safe and effective methods for the treatment of bilateral brachiocephalic-superior vena cava obstruction.