35例肺癌累及上腔静脉患者的外科治疗

目的探讨肺癌累及上腔静脉行手术治疗的策略及技巧，以提高手术疗效，延长患者的生存期。方法回顾性分析35例肺癌累及上腔静脉手术治疗患者的临床资料，于术前、术中测量上腔静脉压力，记录上腔静脉阻断时间，有无眼结膜水肿；上腔静脉置换患者应用国产涤纶及膨体聚四氟乙烯人工血管，直径为14mm或16mm；应用4—0Prolene无创伤滑线连续外翻缝合；术后观察人工血管栓塞、吻合口出血等情况。结果20例上腔静脉置换患者中行人工血管与无名静脉和右心房吻合，未阻断上腔静脉5例，上腔静脉阻断15例，阻断时间8～35min。术中和术后发现眼结膜水肿和无水肿患者上腔静脉阻断时间分别为17～35min和8～20min（P=0．005）。上腔静脉阻断患者术前上腔静脉压力为20-45cmH2O，术中最高压力达37～56cmH2O。术中和术后有眼结膜水肿和无水肿患者术中最高上腔静脉压力分别为48～56cmH2O和37～47cmH2O（P=0．000）。无手术和围术期死亡，术后因胸腔引流量多再次开胸止血1例，未发现人工血管栓塞者。随访32例，随访时间4～130个月，失访3例，总的中位生存期为35个月。结论肺癌累及上腔静脉患者行手术治疗时，为避免脑水肿，术中可采取有关措施不阻断或减少上腔静脉阻断时间；选择合适长度及相应粗度的膨体聚四氟乙烯人工血管，采用无创伤滑线连续外翻缝合，以保持吻合口平整、严密是避免血管栓塞和出血的关键。

Surgery Treatment for Thirty-five Patients with Lung Cancer Invading the Superior Vena Cave

Objective To analyze the strategy and skill of resection for lung cancer invading the superior vena cava （SVC） and improve the surgical treatment results. Methods An analysis of 35 patients who underwent surgery for lung cancer invading the SVC was performed. The pressure of SVC before and during operation, and the time of clamping the SVC were recorded. The conjunctival oedema was observed. 14 mm or 16 mm diameter terylene or expanded polytetrafluoroethylene graft artificial vessel were used to replace SVC. The continuous everted suture was applied with 4-0 Prolene. The embolism of artificial vessel and stomal hemorrhage were observed after operation. Results The SVC replacement with prothesis were performed in 20 patients in which the SVC hadn＇t clamped in 5 patients. The clamping time was 8-35 mins for another 15 patients with SVC clamped. The clamping time were 17-35 mins and 8-20mins respectively for patients with or without conjunctival oedema. The pressure of SVC was 20- 45cmH2O before operation and the maximal pressure was 37-56cmH2O during operation for patients with clamping SVC. The maximal pressure during operation was 48-56cmH2O and 37-47cmH2O for patients with or without conjunctival edema, the difference was significant （P= 0. 000）. No mortality or embolism of artificial vessel, but the stomal hemorrhage was found for one patients cured by reoperation. Thirty-two patients was followed up for 4-130 months,the median survival time was 35 months. Conclusion No clamping of SVC or short time clamping with some operative skill can avoid the occurrence of cerebral edema. Selecting suitable length and roughness of the expanded polytetrafluoroethylene artificial vessel and continuous everted suture with suitable slide suture is important for avoiding the occurrence of embolism and the stomal hemorrhage.