恶性肿瘤合并上腔静脉综合征的急诊处理

目的 探讨恶性肿瘤合并上腔静脉综合征的急诊处理及临床疗效。方法 43例恶性肿瘤合并上腔静脉综合征患者，根据原发肿瘤性质的不同，急诊放疗或化疗，同时辅以脱水、大剂量激素等，迅速缓解上腔静脉压迫症状，然后进行原发病治疗。结果 24小时内症状缓解率为32.6％，72小时总有效率为93.0％。2周内完全缓解率为23.3％，4周内完全缓解率为87.5％。1例患者无缓解，全组无死亡。 结论 放射治疗是治疗恶性肿瘤所致的SVCS的主要方法，特别是非小细胞肺癌；对化疗敏感的肿瘤所致上腔静脉综合征，应首选对原发肿瘤有效的联合化疗方案，能使肿瘤短时间内发生退缩，快速缓解症状和体征;病理诊断不明的恶性肿瘤所致的上腔静脉综合征，病情危急时放疗可首选，以免延误诊治时机。

Emergency treatment of superior vena cava syndrome in malignant tumors

Objective To evaluate the clinical effect of emergency treatment of superior vena cava syndrome in malignant tumors. Methods 43 cases of malignant tumors with superior vena cava syndrome underwent emergency treatment according to the character of primary tumors, treatment methods included radiotherapy or chemotherapy accompanied with dehydration and high dose hormone. The aim was to improve clinical symptoms and signs of superior vena cava syndrome quickly, then, primary tumors were treated. Results The effective rate was 32.6% within 24 hours and was 93.0% within 72 hours. Complete response rate was 23.3% within 2 weeks and was 87.5% within 4 weeks. Only one case was non-effective, all patients survived. Conclusion Radiotherapy is main way in treatment of superior vena cava syndrome in malignant tumors, especially in non-small cell lung cancer. Superior vena cava syndrome in tumors which are sensitive to chemotherapy is treated by combined chemotherapy, which can deflate tumor and improve clinical symptoms and signs. Radiotherapy is also preferred to emergency superior vena cava syndrome in malignant tumors without pathological diagnosis, which can obtain opportunity for diagnosis and treatment.