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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 using vascular repair and reconstruction in the treatment of thoracic tumors in patients with superior vena cava syndrome (SVCS). Methods From October 2008 to June 2016, 26 patients with thoracic tumors and SVCS were treated. 18 males and 8 females; aged 27 to 70 years, mean 45.9 years old. Tumor types: Thirteen B1 ~ B3 thymomas, 6 thymoma, 3 large B-cell lymphoma, 1 T-lymphoblastic lymphoma, 1 malignant teratoma, and 1 squamous cell carcinoma of the right , Carcinoid in 1 case. Tumor diameter 8 ~ 15 cm, an average of 10 cm. Patients with varying degrees of neck, facial and upper extremity edema, jugular vein engorgement, chest wall collateral circulation filling. The superior vena cava pressure is 2.45 to 5.39 kPa. Intraoperative expansion of tumor removal and invasion of the superior vena cava system, 7 cases of superior vena cava repair surgery, 19 cases of superior vena cava or anonymous vein artificial vascular reconstruction. Results There was no perioperative death in all patients, and the symptoms of superior vena cava occlusion were eliminated. Postoperative pulmonary infection in 4 cases, 1 case of respiratory muscle weakness, right chylothorax in 1 case. Twenty-four patients were followed up for 2 ~ 92 months with an average of 37 months. Two patients were lost to follow-up. The 1, 3, 5-year survival rates were 83.3% (20/24), 41.7% (10/24) and 25% (6/24) respectively. Of the 6 patients who survived 5 years, 1 was type B1 thymoma, 3 was type B3 thymoma, and 2 was large B-cell lymphoma. Conclusions The SVCS caused by a comprehensive evaluation of resectable thoracic tumors can be quickly and effectively relieved clinical symptoms and improve the quality of life of patients after SVT has been expanded and resected in the surgery and invaded the superior vena cava.