无阻断上腔静脉重建术在复杂纵隔肿瘤外科治疗中的应用

The application of non-blocking superior vena cava reconstruction in surgical treatment of complex mediastinal tumors

目的探索无阻断上腔静脉重建术在侵犯上腔静脉的复杂纵隔肿瘤外科治疗中的应用,以改进手术方法,提高手术质量,延长患者生存期。方法将22例侵犯上腔静脉的复杂纵隔肿瘤患者,分为试验组11例:实施无阻断上腔静脉切除、人工血管双侧无名静脉-右心耳、心房吻合术;对照组11例:实施上腔静脉阻断下上腔静脉局部切除、人工血管重建术;术中监测单侧无名静脉、上腔静脉阻断时间、颈内静脉压力、生命体征、睑结膜有无水肿等反应颅内高压、脑水肿的指标变化情况。结果试验组:单侧无名静脉阻断时间(23.2±6.3)min。术前颈内静脉压力(29.1±6.3)cm H_2O(1 cm H_2O=0.980665 Pa),术中同侧无名静脉阻断后,压力(36.7±4.6)cm H_2O,较术前明显升高,差异有统计学意义(P<0.05);关胸前颈内静脉压力(10.3±3.5)cm H_2O,较术前明显下降,差异有统计学意义(P<0.05)。术中、术后无脑水肿发生。对照组:上腔静脉阻断时间(21.3±5.9)min。术前颈内静脉压力(27.6±8.2)cm H_2O,术中上腔静脉阻断后,颈内静脉压力(48.6±7.3)cm H_2O,较术前明显升高,差异有统计学意义(P<0.05);关胸前颈内静脉压力(9.7±2.9)cm H_2O,较术前明显下降,差异有统计学意义(P<0.05)。术后睑结膜水肿4例,无脑水肿发生。对照组术中颈内静脉压力明显高于试验组,差异有统计学意义(P<0.05)。结论无阻断上腔静脉重建不阻断脑部血液回流,避免了上腔静脉阻断时脑部血液回流障碍这一病理过程出现,从机制上避免了脑水肿等严重并发症的发生,为侵犯上腔静脉的复杂纵隔肿瘤外科治疗提供了新方法。

Objective To explore the application of non-blocking superior vena cava reconstruction in the surgical treatment of complex mediastinal tumors invading the superior vena cava,so as to improve the operative skill and quality,to prolong the survival time of patients. Methods The 22 patients with complicated mediastinal tumor involved superior vena cava were divided into the trial group（11 cases）：received implementation without blocking the superior vena cava resection and artificial vascular bilateral innominate vein-right aturicle,cardiac atrium anastomosis and control group（11 cases）：superior vena cava occlusion of superior vena cava local resection,artificial vascular reconstruction. And unilateral innominate vein,superior vena cava occlusion time,jugular venous pressure,vital signs and palpebral conjunctiva with or without edema were monitored. Results The trial group：Unilateral innominate vein occlusion time（23.2 ±6.3）min. Before surgery,the jugular venous pressure was（29.1±6.3）cm H_2O,intraoperative ipsilateral innominate vein occlusion after pressure was（36.7±4.6）cm H_2O,was significantly higher than that before surgery（P〈0.05）;closed chest internal jugular venous pressure was（10.3±3.5）cm H_2O,decreased significantly（P〈0.05）. There was no intraoperative and postoperative cerebral edema. The control group：superior vena cava occlusion time（21.3±5.9）min. Before surgery,the jugular venous pressure was（27.6±8.2）cm H_2O,intraoperative venous occlusion,jugular venous pressure was（48.6±7.3）cm H_2O,significantly higher than the preoperative（P〈0.05）;closed chest internal jugular venous pressure was（9.7 ±2.9）cm H_2O,decreased significantly compared with the preoperative（P〈0.05）;4 cases suffered from postoperative conjunctival edema,but no brain edema. In control group jugular venous pressure was significantly higher than the trial group（P〈0.05）. Conclusion Non-blocking superior vena cava reconstruction doesn＇t blocking brain blood circulation,thus avoid the pathological process of brain blood flow interruption by the superior vena cava blocking,and the occurrence of serious complications such as cerebral edema from the mechanism,which could provide a new method for surgical treatment of complicated mediastinal tumor invased superior vena cava.