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。     

血管内支架置入术治疗肺癌引起的上腔静脉综合征

目的:观察血管内支架置入治疗肺癌引起的上腔静脉综合征的疗效。方法:对56例肺癌引起的上腔静脉综合征患者行经股静脉上腔静脉内支架置入治疗。结果:56例患者均成功置入支架,患者症状缓解。8例支架内继发血栓形成,其中1例支架内再次置入支架,7例经溶栓后症状缓解。结论:血管内支架置入术是一种治疗肺癌引起的上腔静脉综合征安全有效的方法。     

上腔静脉综合征支架植入术后并发症分析

目的 探讨上腔静脉综合征(SVCS)支架植入术的并发症及其影响因素,以便制定合理的预防和处理措施.方法 对39例不同原因所致的SVCS患者的临床资料进行回顾性分析.39例患者均行静脉造影,明确上腔静脉狭窄位置、程度、范围,然后行上腔静脉支架植入术.支架植入后以狭窄程度<50%或狭窄程度减少20%以上,同时患者症状在治疗后短期缓解作为支架植入有效的标准,观察术后并发症情况.结果 39例共植入支架40枚.术后35例患者症状明显好转,有效率89.7%(35/39).6例发生并发症,发生率15.4%,其中1例因术后化疗有效、病变缩小致支架移位,症状未加重而未予处理;1例因未抗凝等后续治疗导致血栓形成,后行溶栓及放射治疗致支架移位,患者自动出院;1例因植入大网眼Gianturco Z形支架,肿瘤向网眼内生长导致再狭窄,患者自动出院;急性肺梗死及急性右心功能不全各1例,内科保守治疗后症状缓解;急性心包积液1例,急诊行心包抽液后症状缓解.结论 SVCS支架植入术并发症种类较多,部分后果严重.需根据病因选择合适的治疗方法和合适的支架型号,术中操作轻柔仔细,重视术后处理等方能有效减少并发症.     

应用腔静脉Z型支架治疗上腔静脉阻塞综合征

目的:评价国产腔静脉Z型支架治疗肺癌所致上腔静脉阻塞综合征的临床价值。方法:本组19例肺癌患者中,右肺上叶病变直接导致上腔静脉阻塞12例,纵隔淋巴结转移导致上腔静脉阻塞7例。右股静脉入路,将导管送入狭窄段远端并行DSA检查,测量狭窄段的长度和正常上腔静脉的直径。理想的支架直径应大于正常上腔静脉直径10%,支架长度应越过狭窄段两端1~2cm。术后应用透视或胸片观察支架位置,Doppler随访支架开通情况。结果:放置支架成功后,造影显示对比剂顺利通过开通的支架内,侧枝循环消失,平均上腔静脉压力由术前的27.3±8.4cmH2O降为14.2±3.7cmH2O,支架放置前后对比差异有显著性意义。结论:应用国产腔静脉Z型支架治疗肺癌伴上腔静脉阻塞综合征是微创、有效的治疗方法。     

肺癌致上腔静脉综合征继发病变类型及介入治疗CT研究

目的探讨肺癌致上腔静脉综合征(SVCS)继发病变CT表现类型及介入治疗价值。方法病理确诊肺癌致SVCS51例,其中7例行上腔静脉(SVC)支架植入术,回顾分析上腔静脉梗阻程度、继发病变CT表现及支架植入术后CT表现的变化,并作统计分析。结果(1)继发病变CT表现:单纯侧枝循环建立与开放14例、单纯胸壁肿胀12例、二者均有16例、二者均无9例,肺癌致SVCS时上腔静脉梗阻程度不同,胸部侧枝循环和/或胸壁水肿CT显示率不同(P<0.05)。肺癌致SVCS时血栓形成(或癌栓)7例。(2)上腔静脉支架植入术后CT表现的变化:7例成功行此治疗后CT示上腔静脉通畅,侧枝循环和胸壁水肿减退。结论肺癌致SVCS继发病变包括侧枝循环建立与开放、胸壁肿胀、上腔静脉梗阻端血栓形成,前二者CT表现与梗阻程度有关,且有助于判断支架植入术近期疗效。     

经皮经腔内支架成形术治疗上腔静脉综合征

目的 总结经皮经腔介入内支架成形术治疗上腔静脉综合征的经验，并评价其疗效。方法 使用西门子1200mAC形臂机，采用“Z”形不锈钢裸支架，对15例上腔静脉综合征患者行经皮经腔介入治疗。释放支架使用RUPS－10014鞘及90cm长鞘。15例中男12例，女3例，年龄54－72岁，平均63岁。12例为中心型肺癌，2例为转移瘤，1例为恶性胸腺瘤。13例经右颈静脉入路，2例经右股静脉入路。并对其中13例行支气管动脉灌注化疗。结果 15例患者14例置入支架15枚，1例失败，2例并发血栓形成。无死亡及其他严重并发症。11例术后24h内症状缓解，1周内症状基本消失。结论 内支架治疗上腔静脉综合征安全有效，可以明显延长患者生存时间。     

恶性肿瘤所致上腔静脉综合征的介入治疗

目的 探讨恶性肿瘤所致上腔静脉综合征的介入治疗方法 和疗效. 方法 经股静脉或颈内静脉入路对42例因恶性肿瘤所致上腔静脉综合征患者行介入治疗.结果 42例患者介入治疗前上腔静脉压力平均为(28.5±7.2)cmH2O,介入治疗后压力平均为(15.1±3.5)cmH2O,差异具有显著性(P<0.05).所有患者在术后2～5 d内症状缓解.42例患者均先采用经股静脉穿刺插管入路,32例治疗成功,10例因导丝未能探寻通过狭窄段,改行经颈内静脉穿刺插管入路,使得治疗取得成功.42例患者均无严重并发症. 结论 介入治疗是治疗晚期恶性肿瘤所致上腔静脉综合征的首选方法.     

~(125)I粒子植入治疗肺癌所致上腔静脉综合征的临床效果观察

目的探讨125I粒子植入治疗肺癌所致上腔静脉综合征的临床疗效和安全性。方法 23例肺癌所致上腔静脉综合征患者均接受CT引导下125I粒子植入治疗,术后辅以脱水、利尿及抗感染,观察患者治疗前后的近、远期疗效及不良反应。结果术后1个月复查胸部CT,并结合临床资料评价疗效:完全缓解(CR)6例(26.1%),部分缓解(PR)14例(60.9%),病变稳定(SD)2例(8.7%),病变进展(PD)1例(4.3%),有效率(RR)为87.0%。随访12个月,6个月总生存期(OS)率为78.3%(18/23),12个月OS率为56.5%(13/23)。且治疗后未见明显血液及肝肾毒性,未见治疗相关的放射性损伤。结论125I粒子植入治疗肺癌所致上腔静脉综合征近、远期疗效肯定,不仅能迅速缓解临床症状、不良反应可耐受,且能延长患者的生存期。     

恶性肿瘤所致上腔静脉压迫综合征的介入治疗

目的：探讨采用介入方法治疗恶性肿瘤所致上腔静脉阻塞综合征（SVCS）的疗效及临床意义。方法：24例上腔静脉阻塞综合征患者,经右侧股静脉入路,以猪尾巴导管于狭窄段近端或远端造影,明确狭窄部位、长度、程度,无局部血栓形成者直接置入Wallstent支架（Boston Scientific,USA）,合并血栓病例留置溶栓导管局部溶栓后再置入支架。结果：24例全部开通成功,手术成功率100%,狭窄段平均长度4.6 cm（3～7 cm）。3例置入2枚支架,其余患者均置入1枚支架。9例在支架置入前行溶栓治疗。开通前后梗阻远侧卧位测静脉压,术前（27.3±1.8）cmH2O,术后降至（4.5±0.8）cmH2O,置入支架后造影示侧支静脉完全消失,上腔静脉阻塞症状于术后即刻至术后3 d完全消退。随访8～26个月,11例术后5～10个月内死亡,13例存活,所有病例上腔静脉阻塞症状未再复发。结论：上腔静脉支架置入术联合导管局部溶栓是治疗恶性肿瘤所致上腔静脉阻塞综合征有效的微创治疗方法。     

Malignant superior vena cava obstruction: Stent placement via the subclavian route

Over a 3-year period 23 patients with malignant superior vena cava obstruction were referred for interventional management. They underwent repeat localized central venography and deployment of self-expanding Wallstents. All patients (age range 26-89 years) were approached by the subclavian route using 29 stents. The stent was used to exclude thrombus in the contralateral brachiocephalic vein in five patients and histologic information was available in all patients. Retrospective analysis of the clinical records was used to assess symptom-free survival and symptom recurrence. All patients reported an improvement in symptoms within 24 hr of the procedure. There was 100% technical success. Primary clinical success was achieved in 19 of 23 patients followed-up to their death with no symptom recurrence (range 1-34, mean 15 weeks). In four patients symptoms recurred but only one patient was referred for re-intervention, which was successful. Complications included single cases of early post-stent rethrombosis, distal slip on deployment, and distal slip on balloon dilatation. There were no puncture-related complications.     

介入治疗癌性上腔静脉综合征(附7例报告)

目的：评价选择性支气管动脉灌注化疗（BAIC）治疗癌性上腔静脉综合征（SVCS）的效果。方法：对7例诊断明确的中晚期肺癌及淋巴瘤患者，并发严重的SVCS行BAIC治疗9次，其中5例各治疗1次，2例各治疗2次。结果：7例SVCS患者经BAIC治疗后，全部病人的主要症状与体征得到有效控制和／或明显改善，未发生与该技术操作有关的严重并发症。结论：BAIC治疗中晚期肺癌的严重并发症SVCS，近期疗效确切，且在技术上是成功的。     

Endovascular stenting for the management of port-a-cath associated superior vena cava syndrome

Port-a-cath systems are often essential for the administration of long-term chemotherapy in the treatment of malignancies because they improve venous access, but they are associated with complications, mainly thrombosis of central veins. In the present report, we describe a case of right subclavian and superior vena cava port-a-cath-related thrombosis causing superior vena cava syndrome (SVCS) in a patient affected by Hodgkin’s disease. The patient underwent percutaneous revascularization with stent positioning, experiencing immediate relief of symptoms. Endovascular procedures for the treatment of nonmalignant SVCS seem to represent a challenging therapeutic option.     

原发性肝癌致下腔静脉阻塞的介入治疗

目的研究介入治疗肝癌所致下腔静脉梗阻的疗效及方法。方法6例患者,临床主要症状有腹胀、腹壁静脉曲张和下肢浮肿等。均为肝右叶病变压迫侵蚀下腔静脉所致的狭窄阻塞。治疗方法采用先溶栓,而后球囊扩张和内支架植入。结果6例患者狭窄阻塞的下腔静脉均开通成功,下腔静脉血流通畅,压力由术前的4.0kPa(1kPa=7.5mmHg)降至2.1kPa,无严重并发症。结论采用介入方法开通由于肝癌所引起的下腔静脉狭窄阻塞,疗效肯定,可提高患者的生活质量,延长患者的生存时间。     

经皮上腔静脉成型术治疗上腔静脉阻塞综合征

目的　探讨经皮上腔静脉支架成型术治疗上腔静脉阻塞综合征的方法及临床价值。方法　上腔静脉阻塞综合征患者 1 5例 ,包括肺癌伴纵隔淋巴结转移 1 0例 ,非霍奇金淋巴瘤 3例 ,食管癌伴纵隔淋巴结转移 2例 ,均先行右锁骨下静脉或肘静脉穿刺插管至阻塞上段作造影、测压 ,显示阻塞的部位、程度、侧支循环及有无血栓等情况 ,再经右侧股静脉穿刺入路置放上腔静脉支架。结果　 1 5例患者均 1次成功地植入上腔静脉支架 ,1例患者因狭窄范围超过 1 0cm而导入 2枚支架 ,其余均置入 1枚支架。术后造影显示血流恢复通畅 ,手术前后梗阻远端测压从术前的 (30 .5± 2 .3)cmH2 O降到术后的 (8.8±1 .5 )cmH2 O(均为卧位测压 ) ,差异有显著性 (P <0 .0 1 )。术后造影侧支静脉不再显影 ,上腔静脉阻塞症状明显改善 ,随访 6个月 ,除 1例患者因合并血栓经局部溶栓、球囊扩张治疗后症状改善 ,其余患者均无阻塞症状复发。结论　经皮上腔静脉成型术创伤小、恢复快、疗效确切 ,是治疗上腔静脉阻塞综合征的有效方法。     

Endovascular treatment of stenoses in the superior vena cava syndrome caused by non-tumoral lesions

We report our experience in percutaneous treatment of non-tumoral superior vena cava syndrome (SVCS) between December 1998 and July 2001. During a period of 2.5 years, 9 patients (age range 27–84 years, mean age 50 years) were treated percutaneously for significant non-tumoral SVCS. Symptomatic SVCS were due to dialysis catheters (7), central line (1) and radiation therapy (1). In thrombotic occlusions and severe stenosis, a preliminary in situ thrombolysis was achieved before angioplasty. Patients were followed by echo-Doppler, computed tomography angiography (CTA), magnetic resonance angiography (MRA), or phlebography. Complete recanalization of the veins and immediate resolution of symptomatic SVCS were obtained in all patients, with no procedure-related complication. Thirteen stents were placed in 9 patients with a mean clinical follow-up of 9.1 months (range 2–23 months). One hundred percent patency at 6 months was obtained. Two patients recurred twice and were treated with new stent placement. At 12 months the patency was 67% and assisted patency was 100%. Stent placement in benign symptomatic SVCS is a safe and minimally invasive procedure, with no technical and clinical complications in our experience. It allowed immediate relief of symptoms, and in dialysed patients could provide continued use of hemodialysis access. Close clinical surveillance is mandatory to assess stent patency. Electronic Publication     

Computed tomographic evaluation of compression of the superior vena cava and its tributaries

Observations on computed tomography (CT) of 15 patients with compression of the superior vena cava (SVC) and its tributaries are reported and compared with clinical, radiographic and surgical findings. The site of compression in 14 patients was accurately determined by CT, which could delineate the presence of intraluminal clot and extrinsic compression of venous structures, as well as associated mediastinal masses. Collateral superficial vessels were identified in nine patients with contrast-enhanced scans. Contrast-enhanced mediastinal and chest CT was shown to provide detailed anatomic and physiologic information about the etiology of SVC syndrome.