纵隔镜检查同期血管支架置入术诊治上腔静脉综合征

Clinical significance of mediastinoscope on superior vena cava syndrome followed by stenting

目的 总结电视纵隔镜检查术后同期行上腔静脉支架置入诊断治疗上腔静脉综合征(SVCS)的临床经验,探讨其临床应用价值.方法 回顾性分析2007年11月至2013年10月间9例上腔静脉综合征患者的临床资料,术前均未获得明确病理诊断.采用弹簧气管插管静脉复合全身麻醉,先行电视纵隔镜检查术,同期再经股静脉置入上腔静脉支架治疗.结果 行标准颈部电视纵隔镜检查术6例、胸骨旁电视纵隔镜检查术2例、联合颈部与胸骨旁电视纵隔镜检查术1例.9例均获得明确病理学诊断,无手术死亡,并发渗血1例,填塞压迫后止血.上腔静脉支架置入术后即刻右肘正中静脉压平均(18.6±5.1) cmH2O,24h后平均(13.5±3.3)cmH2O,48 h后平均(11.3±2.5)cmH2O,72 h后平均(10.3±2.0)cmH2O,72 h内静脉压明显下降至正常水平(F=67.245,P＜0.01);临床症状明显缓解,随访中无上腔静脉梗阻复发.结论 电视纵隔镜检查同期行上腔静脉支架置入手术安全、有效,是其他技术无法获得明确病理诊断的上腔静脉综合征可靠的诊断治疗方法.

Objective To summarize the clinical experiences of video-mediastinoscopy followed by stenting procedure in treating the superior vena cava syndrome (SVCS),and to investigate their application significant.Methods Nine patients with SVCS without clear histologic diagnosis before procedure were reviewed retrospectively,who were admitted into hospital from November 2007 to October 2013.All of 9 patients were received video-mediastinoscopy and they did not performed pathological check.They were placed the endovascular stent.Results Video-mediastinoscopy followed by stenting procedure 6 cases,parasternal TN mediastinoscopy 2 cases,joint neck and parasternal TV mediastinoscopy 1 case.Nine cases have received a clear pathological diagnosis.There was no death case in-hospital.The operative complication was hemorrhage of 1 case.The cubital venous pressures were (18.6±5.1) cmH2O at stending,(13.5±3.3) cmH2O,(11.3±2.5) cmH2O,(10.3± 2.0) cmH2O at 24,48,72 h after stending,and down to the normal at 72 h (F =67.245,P ＜0.01).The clinical symptoms were obviously relieved.All of them were remained free from SVCS during the follow-up.Conclusion The hybrid procedure of video-mediastinoscopy followed by stenting placement is a highly effective and safe treatment.It can accurately provide informations on diagnosis and treatment.