血管内支架治疗非小细胞肺癌合并上腔静脉综合征的疗效

Observation of endovascular stent insertion for non-small cell lung cancer patients with superior vena cava syndrome

目的评价血管内支架治疗非小细胞肺癌合并上腔静脉综合征的疗效和安全性。方法收集123例非小细胞肺癌合并上腔静脉综合征患者的临床资料，根据是否接受血管内支架治疗分为支架组（64例）和对照组（59例），分析两组患者的上腔静脉梗阻症状缓解情况、并发症和生存情况。结果支架组和对照组患者上腔静脉梗阻症状的完全缓解率分别为92．0％和42．0％，差异有统计学意义（P〈0．001）。支架组患者达到完全缓解的时间为（3．76±2．83）d，对照组患者达到完全缓解的时间为（28．08±16．06）d，差异有统计学意义（P〈0．001）。支架组和对照组症状完全缓解后的复发率分别为12．0％和16．0％，差异无统计学意义（P=0．607）。支架组患者症状完全缓解后出现复发的中位时间为2．7个月，对照组患者症状完全缓解后出现复发的中位时间为1．1个月，差异无统计学意义（P=0．533）。支架组中，血栓形成3例，支架狭窄1例，并发症发生率为6．3％；对照组中，血栓形成1例，并发症发生率为1．7％；两组患者的并发症发生率差异无统计学意义（P=0．201）。123例患者中，存活7例。支架组和对照组患者的中位生存时间分别为8．0和5．5个月，差异无统计学意义（P=0．382）。结论血管内支架可以快速、有效地缓解非小细胞肺癌合并上腔静脉综合征的症状，治疗安全性好，可作为缓解上腔静脉梗阻症状的首选治疗方案。

Objective To evaluate the effectiveness and safety of endovascular stent insertion for non-small cell lung cancer patients with superior vena cava syndrome. Methods We retrospectively studied 123 patients referred to our hospital for the treatment of non-small cell lung cancer presenting with superior vena cava syndrome. Patients were devided in two groups according to the use of endovascular stent insertion in superior vena cava syndrome or not. 64 patients underwent endovascular stent insertion was designed as the stenting group and 59 without stenting as control group. The differences between the two groups in complete response, complication and survival were analyzed. Results The complete response rate of superior vena cava obstruction was 92.0% for the stenting group, and 42.0% for the control group, showing a significant difference between the two groups （ P 〈 0. 001 ）. The median time to complete response was （3.76±2.83 ） days in the stenting group, significantly shorter than that of the control group （28.08±16.06） days （P 〈0.001 ）. The relapse rate after complete response was 12.0% in the stenting group and 16.0% in the control group, showing a non-significant difference between the two groups （P=0.607）. The median time to relapse was 2.7 months in the stenting group and 1.1 months in the control group （P = 0. 533）. In the stenting group, stent stenosis occurred in 1 case and thrombosis was observed in 3 cases. The incidence rate of complications was 6.3%. Thrombosis occurred in 1 case of the control group, with an incidence rate of complications of 1.7%, showing a non-significant difference between the two groups （P = 0. 201 ）. Seven among the 123 patients were still alive at the endpoint of following up. The median survival time was 8.0 months （ stenting group） and 5.5 months （ control group） （ P = 0. 382）. Condusions Endovaseular stent insertion is effective and safe for non-small lung cell cancer patients with superior vena cava syndrome, and it may be recommended as the first choice for palliative treatment of superior vena cava obstruction.