血管外科技术在胸部肿瘤外科中的应用

目的　探讨上腔静脉及无名静脉切除 ,人工血管置换术在胸部肿瘤外科治疗中的应用及其临床效果。方法　实验研究 :健康成年犬 18只 ,分为单纯阻断组 :阻断上腔静脉或上腔静脉奇静脉联合阻断 (9只 ) ;人工血管置换组 :切除上腔静脉 ,行人工血管置换 (9只 )。对上腔静脉阻断前后上腔静脉压力的变化、人工血管置换后的病理改变、抗凝治疗及长时间阻断上腔静脉后脑组织的病理改变进行分析。临床研究 :胸部肿瘤患者 56例 ,其中肺癌 42例 ,纵隔肿瘤 14例。行肿瘤根治切除术及受侵上腔静脉和 (或 )无名静脉切除人工血管置换 ,并对患者进行长期随访。结果　实验研究 :实验犬上腔静脉加奇静脉阻断后 ,上腔静脉系统压力为 (49 2 8± 14 72 )cmH2 O(1cmH2 O =0 0 98kPa) ,高于单纯上腔静脉阻断的 (3 7 83± 1 3 5)cmH2 O (P <0 0 5) ;腔静脉阻断 2h未见脑实质充血及水肿 ;人工血管置换组犬术后 1个月血管腔内壁已有纤维素沉积 ,2个月始有部分血管内皮细胞移行覆盖 ;未应用抗凝治疗情况下血管无附壁血栓形成。临床研究 :全组患者无围手术期死亡及术后近、远期上腔静脉系统梗阻症状。肺癌组患者 1、3、5年生存率分别为 84%、41%、3 9% ;纵隔肿瘤患者术后 1例死亡。结论　血管外科技术的应用 ,扩大了胸部肿瘤外科手

Application of vascular surgery in the treatment of thoracic neoplasm

ObjectiveTo investigate superior vena cava(SVC) and anonymous vein resection with prosthesis replacement for lung carcinoma and mediastinal tumor, and to assess the surgical procedure and prognosis. Methods Experimental research: Eighteen adult dogs were divided randomly into two groups. Group A ( n=9) underwent blocking of the SVC system, and Group B( n=9) underwent SVC resection with prosthesis replacement. The SVC pressure and histological changes of brain tissue were measured and evaluated for group A. The histological changes of prosthesis were studied in group B. Clinical research: Fifty-six patients with thoracic neoplasm were studied, of which 42 were lung carcinoma and 14 were mediastinal tumor. Resection of primary lesions and metastatic lymph nodes with replacement of SVC system were performed for all patients. Long-term follow-up was performed. Results Experimental research: In Group A , the pressure of SVC was higher when both SVC and the azygous vein were blocked as compared to SVC blocking only ( BXP<0.05); hyperemia and edema of brain tissue were not observed in two-hour obstruction. The inner face of vascular prosthesis was covered with fibrin two months after operation in group B. Vascular endothelial cells were found to grow in it, and there was no thrombosis without anticoagulation. Clinical research revealed that there was no death associated with the operation and there was no early or late obstruction of SVC. The survival rates of the patients with lung carcinoma in 1,3 and 5 years were 84.2% 40.9% and 38.9% respectively. The patients with mediastinal tumor were all alive except 1 patient who died of metastasis. Conclusions Radical resection combined with prosthesis replacement of SVC system extends the indications of thoracic neoplasm resection and improve the long-term survival rate and living qualities of the patients. It may be recommended in the surgical treatment of thoracic tumor.