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。

CT Research on Types and Interventional Therapeutic Significance of Secondary Lesions of Superior Vena Cava Syndrome Caused by Pulmonary Carcinoma

Objective To investigate CT appearances and its interventional therapeutic value of secondary lesions of superior vena cava syndrome(SVCS)caused by pulmonary carcinoma.Methods The obstructive extent of SVCS,CT appearaces of secondary lesions of SVCS and changes on CT after SVC stents placement in 7 of 51 cases with lung cancer resulting in SVCS confirmed pathologically,were analyzed retrospectively and statistically.Results (1)CT appearances of secondary lesions included:simple establishment and opening of collateral circulation in 14 cases,simple swelling of chest wall in 12 cases,both of the two in 16 cases and neither of the two in 9 cases.The collateral circulation and/or swelling of chest wall were different in showing ratio on CT (P<0.05) with the difference of degree of SVC obstruction,and thrombosis (or carcinomatous thrombus)were in 7 cases at one end of SVC obstructive segment,(2)SVC stent placement were performed successfully on 7 cases,obstructive segment of SVC was free,and collateral circulation and swelling of chest wall were relieved.Conclusion Secondary lesions of SVCS caused by pulmonary carcinoma are establishment and opening of collateral circulation,swelling of chest wall,thrombosis(or carcinomatous thrombus)at the end of obstructive segment of SVC,the former two has relationship with extent of SVC obstruction,it is helpful in evaluation of recent therapeutic efficiency after stents placement.