血管修复重建术治疗胸部肿瘤引起的上腔静脉综合征

Application of vascular repair and reconstruction in surgical treatment of superior vena cava syndrome caused by thoracic tumor

目的总结采用血管修复重建术治疗胸部肿瘤引起的上腔静脉综合征(superior vena cava syndrome,SVCS)的临床经验。方法2008年10月—2016年6月,收治26例胸部肿瘤伴SVCS患者。男18例,女8例;年龄27~70岁,平均45.9岁。肿瘤类型:B1~B3型胸腺瘤13例,胸腺癌6例,大B细胞淋巴瘤3例,T前体淋巴细胞性淋巴瘤1例,恶性畸胎瘤1例,右侧肺鳞癌1例,类癌1例。肿瘤直径8~15 cm,平均10 cm。患者均伴不同程度颈部、颜面部及上肢浮肿,颈静脉怒张,胸壁侧支循环静脉充盈。上腔静脉压力为2.45~5.39 k Pa。术中扩大切除肿瘤及受侵上腔静脉系统后,7例行上腔静脉成形修补术,19例行上腔静脉或无名静脉人工血管重建术。结果患者均无围手术期死亡,术后上腔静脉阻塞症状均消除。术后发生肺部感染4例,呼吸肌无力1例,右侧乳糜胸1例。24例获随访,随访时间2~92个月,平均37个月;失访2例。术后1、3、5年生存率分别为83.3%(20/24)、41.7%(10/24)、25%(6/24)。存活5年的6例患者中,分别为B1型胸腺瘤1例,B3型胸腺瘤3例,大B细胞淋巴瘤2例。结论对经综合评估可切除的胸部肿瘤引起的SVCS,术中扩大切除肿瘤及受侵上腔静脉系统后,联合血管修复重建术,可达到迅速有效缓解临床症状、提高患者生存质量的目的。

Objective To summarize the clinical experience of vascular repair and reconstruction for treating superior vena cava syndrome （SVCS） caused by thoracic tumor. Methods Between October 2008 and June 2016, 26 patients with thoracic tumor and SVCS were admitted. There were 18 males and 8 females, aged from 27 to 70 years （mean, 45.9 years）. Tumor was typed as B1-B3 thymoma in 13 cases, thymic carcinoma in 6 cases, large B-cell lymphoma in 3 cases, T lymphocytic lymphoma in 1 case, malignant teratoma in 1 case, right lung squamous cell carcinoma in 1 case, and carcinoid in 1 case. The tumor diameter ranged from 8 to 15 cm with an average of 10 cm. The patients had different degrees of neck, face, and upper extremity edema, jugular vein distention, and chest wall collateral venous filling. The superior vena cava pressure was 2.45-5.39 kPa. After excision of tumor and invading superior vena cava, 7 patients underwent superior vena cava reconstruction and 19 patients underwent artificial vascular replacement. Results There was no perioperative death, and the symptoms of superior vena cava obstruction were eliminated. Postoperative pulmonary infection, respiratory muscle weakness, and right chylothorax occurred in 4 cases, 1 case, and 1 case respectively. Twenty-four patients were followed up 2-92 months （mean, 37 months）, and 2 patients failed to be followed up. At 1, 3, and 5 years, the survival rate was 83.3% （20/24）, 41.7% （10/24）, and 25% （6/24）, respectively. In 6 patients with 5-year survival, there were 1 case of type B1 thymoma, 3 cases of type B3 thymoma, and 2 cases of large B-cell lymphoma.Conclusion For preoperative evaluation of SVCS caused by resectable thoracic tumors, vascular repair and recons- truction technique can be used to quickly and effectively relieve the clinical symptoms and improve the quality of life.