肺癌合并上腔静脉综合征的介入治疗

目的探讨经皮血管内支架植入联合肿瘤供血动脉化疗栓塞治疗肺癌合并上腔静脉综合征的方法及临床价值。方法28例肺癌合并上腔静脉阻塞患者,经螺旋CT和静脉造影明确诊断,以阻塞远侧静脉压大于22mmHg为支架植入适应证,支架植入前明确伴有继发血栓形成患者行抗凝及溶栓治疗,经肘前静脉或股静脉入路,先行狭窄部位球囊扩张术,然后在上腔静脉和头臂静脉狭窄段植入支架,支架植入前后联合支气管动脉栓塞化疗。结果28例患者成功植入支架30枚,3例支架内继发急性血栓形成,经过保留导管溶栓治疗成功溶解血栓,2例术后出现肺栓塞,经过血栓抽吸 抗凝溶栓治疗症状缓解,1例3个月后上腔静脉综合征复发,再次植入1枚支架后上腔静脉重新开通,其余病例在生存期内支架保持通畅。结论上腔静脉支架植入联合支气管动脉栓塞化疗治疗肺癌所致上腔静脉综合征,缓解症状迅速有效、微创、并发症较少,可以明显提高患者的生存质量。

Interventional treatment of lung cancer complicated with superior vena cava syndrome

Objective To evaluate the clinical value of expansible metallic stent implantation with transcatheter arterial chemoembolization in the treatment of superior vena cava syndrome(SVCS)due to primary lung carcinoma.Methods 28 patients with SVCS due to lung cancer were clearly diagnosed with spiral CT and venography.Stents were placed in the SVC only when the pressure was over 22 mmHg in the distal part;in case of thrombosis,the initial treatment of choice was anticoagulation and local thrombolysis through infusion catheters.Angioplasty and stenting were performed through antecubital vein or femoral vein after the thrombi had been dissolved.Transcatheter arterial chemoembolization was carried out before and after the stent implanted.Results 30 stents were successfully implanted in 28 patients.Acute thrombosis occurred in 3 cases after the procedure and cured by local thrombolytic therapy;pulmonary embolization in 2 cases with symptoms relieved after anticoagulation,thrombolysis and aspiration;and 1 case recurred 3 months after the stent implantation was successfully treated with a second stent placement.Other cases had no recurrence of SVCS during their survival periods.Conclusions Expansible metallic stent implantation combined transcatheter arterial chemoembolization is rapidly effective,minimally invasive and less complication for SVCS caused by primary lung carcinoma,with obvious improvement of patient's survival quality.