心内直视术中永存左上腔静脉的外科处理

目的 探讨心内直视术中对永存左上腔静脉(persistent left superior vena cava,PLSVC)的外科处理方法. 方法 回顾性分析江门市中心医院2007年7月至2019年10月21例先天性心脏病合并PLSVC患者的临床资料,其中合并继发孔型房间隔缺损12例,室间隔缺损3例,部分型房室间隔缺损2...     

心脏直视手术中左上腔静脉的处理

心脏直视手术中左上腔静脉的处理卞永生，杨能善，罗毅自１９９０年１月至１９９３年１０月北京安贞医院小儿心外科共施行体外循环心脏直视手术９８９例，有永存左上腔静脉（ＰＬＳＶＣ）者２９例，其中引入左房者３例。现报道如下：临床资料本组２９例中男１４例，女１５...     

永存左上腔静脉患者PICC置管的护理

目的探讨永存左上腔静脉患者PICC置管的安全护理。方法对4例(5例次)永存左上腔静脉患者行PICC置管,重视PICC置管前评估,落实置管后X线摄片会诊,多学科会诊协作;置管后正确评估导管功能,加强随访,密切观察病情变化,建立置管信息数据库。结果 5例次放置于永存左上腔静脉的PICC功能良好,3例患者已结束治疗拔管,1例继续使用中。结论通过专业团队组织多学科协作,加强永存左上腔静脉患者置管前后护理及随访,可保证永存左上腔静脉置管患者的治疗安全。     

右上腔静脉缺如伴永存左上腔静脉合并心内畸形2例

例1 男，28岁。发现心脏杂音20余年。10年前曾在本院诊断为先天性心脏病室间隔缺损伴重度肺动脉高压，病人拒绝手术。查体：胸骨左缘第3肋间可闻及3／Ⅵ级收缩期杂音。心电图示P波I导联倒置，aVR导联直立，电轴右偏，右心室增大，左房心律。胸部X线检查示肺动脉呈瘤样突出，心胸比率0．68。超声心动图检查示先天性心脏病，嵴下型室间隔缺损2．5cm，肺动脉增粗5．0cm，右室壁增厚0．8～1．0cm。动     

肺癌合并上腔静脉综合征的外科治疗

目的报告肺切除合并全上腔静脉切除人造血管置换术治疗肺癌伴上腔静脉综合征患者的结果。方法１９９４年９月～１９９６年１１月，行肺切除合并全上腔静脉切除，人造血管置换重建术，治疗侵及上腔静脉的Ⅲｂ期肺癌３例。其中支气管、肺动脉袖状成型右上叶切除２例，右全肺切除１例。结果本组无手术死亡和严重手术并发症；术后无癌存活超过２８月１例，９月１例，２月１例。结论肺切除合并全上腔静脉切除、人造血管置换重建术，治疗肺癌合并上腔静脉综合征，能明显延长这类患者的近期和长期生存时间。     

肝癌合并下腔静脉癌栓11例的外科治疗体会

目的 探讨并总结肝细胞癌(肝癌)合并下腔静脉(inferior vena cava，IVC)癌栓手术治疗的方法和经验。方法 对11例肝癌合并IVC癌栓患者进行了手术治疗，手术先在入肝血流阻断下作肝癌原发灶切除，然后再阻断IVC血流行切开取栓。结果 本组11例原发灶和IVC癌栓均成功切除，全组无手术死亡，术中、术后均未发生与IVC取栓相关的并发症。平均手术时间为179(120—255)min，平均手术失血量为1482(600—3000)ml，平均肝门阻断和全肝血流阻断时间分别为27．9(12—83)min和16．5(7—28)min。术后发生胸水1例、胆漏1例，均治愈；随访3例已死亡，8例存活1—14个月。结论 肝癌合并IVC癌栓的手术可安全施行，手术应先作原发灶切除再作IVC切开取栓。     

下腔静脉局限性狭窄或阻塞的外科治疗

<正> 新近将布-加氏综合征分为三种类型,即以隔膜为主的局限性狭窄或阻塞(简称Ⅰ型),弥漫性狭窄或阻塞型及肝静阻塞型。我院自1989年11月～2001年12月在收治的353例布-加氏综合征患者中,Ⅰ型为175例(49.6％),现报告如下。就其诊断、并发症的防治及球囊导管的应用加以讨论。 1 临床资料 1.1 一般资料:Ⅰ型患者175例,男97例,女78例。男女之比为1.12:1,年龄13～55岁,平均33岁,病程1月～11月。主要临床表现为上腹胀疼、纳差、心慌、气促和易倦,下肢水肿、腹泻、尿少,合并黄疽者相对较少。上消化道出血或黑便者有15例,主要临床病症有:胸膜壁浅静脉曲张者97例(血流方向呈上行性),肝肿大105例,腹水35例,脾肿大92例,下肢水     

19例左上腔静脉引流入左心房的诊治

目的 总结左上腔静脉引流入左心房的诊治体会.方法 1998年2月至2012年1月收治19例先天性心脏病合并左上腔静脉引流入左心房患儿,男10例,女9例,年龄0.5～12.0岁;体重6～28 kg.均经心脏彩色多普勒、左上肢声学造影及心导管心室造影、CT等检查明确诊断.采用直接结扎或切断缝合、自体心包左心房内隧道、房间隔重建、双向Glenn手术治疗.结果 全组病例无死亡.术后恢复过程平稳.术后随访,最长者已11年,情况良好.结论 左上腔静脉引流入左心房术前确诊较难,加深对其特性的认识可以提高术前检出率,手术治疗效果良好.     

婴幼儿先天性心脏病合并下腔静脉缺如的外科治疗

先天性心脏病合并下腔静脉缺如者少见。 1997～ 1999年 ,我们手术治疗 4例该畸形病儿 ,现报道如下。临床资料　见表 1。　　全组均在全麻下 ,纵劈胸骨切口 ,低温体外循环下行心表 1　本组 4例先天性心脏病合并下腔静脉缺如病儿临床资料病例性别月龄 体重(ｋｇ) Ｘ线胸片心电图彩色超声1女 76左上纵隔一圆形阴影 ,心胸比率 0 7,右位心 ,右房、右室大 ,肺动脉段重度凸出 ,肺血多冠状窦性心律 ,右室肥厚镜面右位心 ,ＶＳＤ ,重度肺动脉高压 ,下腔静脉近心段缺如2男 117右上纵隔一圆形阴影 ,心胸比率 0 6,右房中度增大 ,肺动脉段中度凸出 ,肺…     

婴幼儿法洛四联症外科治疗

目的 探讨婴幼儿法洛四联症手术适应证选择、手术技术及围手术期处理。方法 本组64例，年龄3～36个月，体重3～15kg，60例行根治手术，4例行姑息手术。结果 全组住院死亡4例，死亡率6．2％。随访2～50个月，晚期死亡1例，其余患儿活动能力均增加，效果满意。结论 婴幼儿法洛四联症手术可取得较好效果。     

非体外循环上腔静脉置换术的手术配合

目的 总结非体外循环上腔静脉置换术的手术配合方法。方法 对8例胸部肿瘤合并上腔静脉综合征患者，在非体外循环下行上腔静脉置换术。结果 8例患者手术顺利，术中出血600～2000ml，平均900．0ml；手术时间3～7h，平均4．5h；无术中并发症发生，均痊愈出院。结论 充分的术前准备，娴熟的手术配合。术中密切观察病情变化，是保证手术顺利进行的重要因素。     

上腔静脉和无名静脉的切除及重建治疗纵隔肿瘤

目的　探讨分析纵隔肿瘤根治性切除 ,重建上腔静脉和无名静脉的手术意义及技术方法。　方法　回顾性分析北京协和医院 2 0 0 1～ 2 0 0 3年 11例纵隔肿瘤引起上腔静脉综合征患者的治疗及预后。根治性切除肿瘤 9例 ,其中 2例行心包修补静脉壁成形术 ,7例人工血管置换重建上腔静脉和无名静脉 ;2例部分切除。术中对左、右无名静脉分次阻断 ,单侧阻断时间 2 2 .15± 6 .2 9min,手术出血量 1342 .86± 6 92 .4 8ml。　结果　侵袭性恶性胸腺瘤 4例 ,胸腺癌5例 ,纵隔小细胞癌 2例。术后早期患者静脉梗阻症状即改善 ,无神经系统并发症 ,1例死于肺部感染 ,其余 10例全部健在 ,存活时间已达 6～ 30个月。　结论　上腔静脉和无名静脉的重建可以有效地消除上腔静脉综合征 ,其手术是安全的 ;但应注意病变的范围 ,争取根治性切除是提高生存率的关键。     

Total Occlusion of the Superior Vena Cava Due to Bronchogenic Cyst

Bronchogenic cysts are the most common form of congenital cystic lesions in the mediastinum. Of all cases with bronchogenic cysts, 1/3 are symptomatic. The symptoms vary depending on the location and compression of the adjacent structures of the cyst. Some mediastinal bronchogenic cysts can cause severe respiratory distress due to airway and vascular compression. We herein present a case with a bronchogenic cyst that required venoplasty to the superior vena cava (SVC) due to total occlusion of the SVC.     

上腔静脉综合征的外科治疗(附47例分析)

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。     

Mediastinal Fibrosis and Superior Vena Cava Syndrome

Superior vena cava syndrome is a clear sign for clinicians of infiltrative mediastinal involvement, usually caused by neoplasms in this location, and it is an indicator of poor prognosis. However, other diseases of benign origin can also cause these alterations. We present the case of a 34-year-old patient who debuted with symptoms of superior vena cava syndrome due to idiopathic mediastinal fibrosis, which presented a torpid evolution and few therapeutic alternatives.     

Correction of Left Superior Vena Cava Draining to the Left Atrium Using Extracardiac Techniques

Intraatrial rerouting techniques have been the most common approaches to correcting left superior vena caval drainage to the left atrium in patients without atrial isomerism and with no connecting vein. Although these techniques have proved reliable and successful, there are cases in which extracardiac methods for managing this form of anomalous systemic drainage may be preferable. In the present report, we describe three extracardiac approaches to the correction of left superior vena cava draining to the left atrium.     

Surgical Management of Leiomyosarcoma of the Inferior Vena Cava

Introduction  Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor for which en bloc resection offers the only chance of cure. Due to its rarity, however, optimal strategies for the management of the primary tumor and subsequent recurrences are not well defined. Methods  We performed a retrospective review of patients who underwent surgical resection of IVC leiomyosarcoma. We evaluated clinical presentations, operative techniques, patterns of recurrence and survival. Results  From 1990 to 2008, nine patients (four females) were identified. Median age was 55 years (40–76). Presentations included abdominal pain (n = 5), back pain (n = 2), leg swelling (n = 4) and abdominal mass (n = 2). Pre-operative imaging studies showed tumor location to be from the right atrium to renal veins (n = 1), retrohepatic (n = 5), and from hepatic veins to the iliac bifurcations (n = 3). En bloc resection included right nephrectomy (n = 5), right adrenalectomy (n = 4), pancreaticoduodenectomy (n = 1), right hepatic trisectionectomy (n = 1) and right hemicolectomy (n = 1). The IVC was ligated in six patients, and a prosthetic graft was used for IVC reconstruction in three patients. Resection margins were negative in seven cases. Median length of stay was 12 days (range, 6–22 days). Major morbidity included renal failure (n = 1) and there was one post-operative mortality. Five patients had leg edema post-operatively, four of whom had IVC ligation. Median survival was 47 months (range, 1–181 months). Four patients had recurrence and the median time to recurrence was 14 months (range, 3–25 months). Two patients underwent successful resection of recurrence. Conclusions  Curative resection of IVC leiomyosarcoma can lead to long-term survival. However, recurrence is common, and effective adjuvant treatments are needed. In selected cases, aggressive surgical treatment of recurrence should be considered. Presented at the Digestive Disease Week 2008, San Diego, CA, USA, May 2008. Grant Support: NIH K12 HD 049109 (T.C.G.).     

Seminoma With Bronchial Involvement and Superior Vena Cava Syndrome: A Rare Combination

We describe the case of a 45-year-old male who was admitted with clinical signs of superior vena cava syndrome (SVCS). Physical examination showed collar of Stokes and extensive collateral circulation in the neck and anterosuperior thoracic region, as well as a large testicular mass. Fibrobronchoscopy revealed an endobronchial tumor, histopathologically diagnosed as seminoma, with the same characteristics as the testicular biopsy. Treatment was initiated with surgery, chemotherapy and radiotherapy, resulting in a major clinical improvement. We indicate the importance of considering SVCS as an entity related with less common neoplasms such as germ cell tumors.