上腔静脉阻塞综合征的血管内支架治疗

目的 探讨血管内支架治疗上腔静脉阻塞综合征的技术和临床应用效果。方法 9例上腔静脉阻塞综合征患者，原发病灶均由病理组织学诊断为恶性肿瘤(右上肺中央型肺癌)。行右股静脉穿刺，在造影像上测量狭窄长度及正常上腔静脉直径，选择适当支架，原则上支架直径应超过正常上腔静脉直径10％，上下端应超过狭窄段1—2cm。成功后用球囊扩张支架。术后继续治疗原发疾病并抗凝治疗，透视或胸片观察支架位置，多普勒了解上腔静脉通畅情况。结果 支架置入后行DSA见造影剂回流通畅，上腔静脉管径接近正常，侧支循环明显减少。上腔静脉压由开通前平均26．4cmH2O降至15．7cm2O，经统计学处理有显著性差异(P＜0．01)。相关临床症状、体征消失或缓解。头颈部、上肢、胸壁肿胀2天内消退，尿量增多，胸壁浅静脉怒张消失。结论 支架术治疗上腔静脉综合征微创、简单、有效，值得推广。

Superior vana cava syndrome: A therapy by intra-vascular stenting

Objective To study the techniques and clinical applications of intra-vascular stenting in the treatment of superior vana cava obliteration syndrome (SVS). Methods In 9 cases of SVS, primary lesions were all confirmed as malignancy (primary pulmonary carcinoma of right upper lobe) histolo-pathologically. By route of right femoral vein, SVS catheterization and DSA was made. The length of the strictures and the diameters of normal superior vana cavae (SVC) were measured for the choice of appropriate stents. The option of stent diameter is 10% larger than that of normal SVCs. The upper and lower ends of the stent should be 1-2 cm protruding from the ends of the stricture. The stent was dilated with a balloon after its successful placement. Therapy of original lesions was continued together with anticoagulant. Stents were observed about their positions by fluoroscopy or chest films, and about patency of SVC by Doppler. Results After the placement of a stent, DSA revealed the contrast media in the SVCs passed along smoothly, diameters of SVCs almost normal, collateral branches diminished remarkably. Average SVC pressure was decreased from 26.4 cmH 2O before the placement down to 15.7 cmH 2 O, with an obvious difference ( P <0.01 by statistics. Related clinical symptoms and signs disappeared or relieved. Subsidised were swelling of head and neck, upper extremities and chest. Excretion of urine increased. Gorgeous superficial veins in the chest could not be detected any more. Conclusion The therapy of intra-vascular stenting to treat SVS is microinvasive, simple and effective.