摘要
１９８４年１月至１９９４年１２月收治上腔静脉综合征病人４７例，其中３４例施行了手术治疗。病变原因为纵隔肿瘤１２例、纵隔炎症７例、静脉炎１４例、良性病变１２例和异位升主动脉压迫及原因不明各１例，同时伴下腔静脉病变８例。手术方法包括：各种转流术，肿瘤切除加上腔静脉重建或松解术，经右房、经球囊导管下腔静脉扩张术和上腔、无名静脉内血栓内膜切除加心包补片等。术后平均随访３２．５个月，显效５８．６％，改善２４．１％，无效３．５％，复发率为３．４％，死亡１０．３％。结论：手术的选择以病变切除和经胸转流优于经皮下转流；带外支持环ＰＴＦＥ人工血管经胸骨后行颈静脉—下腔静脉转流对缓解症状前景颇好。双侧大隐静脉—颈内静脉转流优于单侧。伴下腔静脉阻塞时，解决单侧病变，可能达到病人可接受的效果。而上腔静脉、无名静脉血栓内膜切除加补片移植和大网膜静脉与颈内静脉吻合为疑难病例提供了更多的选择。
Aim:Superior vena syndrome(SVCS)can be caused by various pathological lesions,either intravascular or extravascular,benign or malignant Thus,the treatment of this syndrome varies from patient to patient.This pater summarized the experience of surgical treatment of this complex syndrome.Material and Method:Fortyseven cases of SVCS admitted to our hospital included 30 males and 10 females with a sex ratio of 3.7∶1.The etiology consisted of mediastinal tumor in 12 cases with benign in 4 and malignant in 8;mediastinitis in 7,fibrosing in 2 and tuberculous in 5;phlebitis in 14,chronic inflammation in 3 and thrombophlebitis in 11;compression by displaced aorta in 1case;other benign lesions in 12 and unknown in 1.Pathological lesions existed in the inferior vena cava(IVC)concurrently in 8 cases.However,only 33 patients underwent surgical treatments including various types of shunt in 28 cases,resection of tumor and reconstruction of the tributary of SVC in 1,partial resection of tumor and lysis of SVC in 1,transright atria IVC membranotomy in 2,balloon dilatation of IVC in 2,thromboendovenectomy of SVC and innominate vein with pericardial graft patching in 1.Results:The mean followup period was 32.5 months.Excellent results were obtained in 58.6%;improvement in 24.1%;poor in 3.5%;and recurrence in 3.5%.The mortality rate was 10.3%.It was concluded that:(1)Resection of lesion and/or major shunt achieved better results;(2)Retrosternal jugularIVC shunt by PTFE prosthesis with external support seems to be better in selected patients;(3)In patients with concurrent occlusive lesion of IVC,twostage operation might give more favorable results than onestage;(4)Bilateral saphenousjugular transplantation was better than unilateral;(5)Thromboendovenectomy of the SVC and omental vein to cervical vein anastomosis might be the last option for the difficult cases.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
1998年第2期81-83,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
上腔静脉综合征
静脉转流术
下腔静脉隔膜
Superior vena cava syndrome Venous bypass Shunting procedure Inferior vena cava web
