肺癌合并上腔静脉综合征的血管内支架及溶栓治疗

目的 探讨上腔静脉内支架置入及局部溶栓治疗原发性肺癌合并上腔静脉综合征（SVCS）的临床价值。材料与方法 采用经皮穿刺股静脉插管的方法对15例肺癌合并SVCS患者分别向狭窄的上静脉置入1枚直径10－14mm、长60－80mm的镍钛记忆合金支架，其中5例经导管注入尿激酶30－42万U局部溶栓治疗。结果 15例支架置入一次成功，上腔静脉血流恢复通畅。14例患者SVCS症状很快消除；1例合并血栓者经局部溶栓治疗后症状显著改善，随访3个月－5年，6例患者成活3个月－3年，无复发；5例患者术后4个月－2年因肺癌死亡时亦无复发。4例患者术后短期内复发支架内血栓阻塞，经局部溶栓治疗后症状显著改善。结论 血管内支架治疗肺癌合并SVCS是一种有效的姑息治疗方法，及时局部溶栓治疗是防止近期复发的良好手段，为了延长这类患者的生存期，必须重视肺癌本身的治疗。

Expansible Metallic Stent Implantation and Thrombolysis in the Treatment of Superior Vena Cava Syndrome Caused by Lung Cancer

Objective　To evaluate expansible metallic stent implantation and local thrombolysis in the treatment of superior vena cava syndrome (SVCS) due to primary lung carcinoma. 　Materials and Methods　Nickel titanium memorial alloying stent, 10～14mm in diameter and 60～80mm in length, was implanted in 15 patients with SCVS caused by lung cancer. The procedure was carried out through percutaneous puncture of the right femoral vein. 　Results　Successful positioning of the stent and the patency of SVC were achieved in all patients. The symptoms of SVCS disappeared immediately in 14 patients. A following-up period lasting 3 months～5 years showed that 5 patients died of tumor progression (4 months～2 years) and 6 patients were survival (3 months～3 years). In 4 patients, thromboembolism of the stent occurred shortly after the procedure, the symptoms were improved after local thrombolytic therapy via a catheter.　Conclusion　Stent implantation for SVCS due to lung cancer seems to be an effective palliative treatment. Local thrombolytic therapy is useful for short-term recurrence. To prolong the survival stage, great attention to the treatment of lung cancer per se should be paid.