腔内支架植入术在上腔静脉阻塞综合征的临床应用及意义

摘要

Objective To explore the clinical curative effect and application experience in treatment of benign and malignant tumor with method of superior vena cava obstruction syndrome (SVCS) caused by blocked.Methods 38 cases of malignant tumor in good caused by blocked syndrome in patients with venous cavity were chosen in this study, pathology confirmed as of 30 cases of malignant tumor,mediastinum benign lesion 8 cases 38 cases were all right femoral venous into the road leading to more than one side in narrow hole straight catheter for proximal or remote imaging,pressure measuring,display stenosis site,length,degree,collateral circulation and had local thrombosis,etc.We directly put the body into Z (COOK,USA),including 5 cases into the road through the narrow segment and shifted to the neck veins into the road.Results All of 38 cases open successful,with the success rate of 100％,narrow section length 3 ～ 8 cm,the average length of (5.12 ± 1.67) cm.Before and after opening the vein obstruction far side-lying position pressure,preoperative (28.1 ± 1.5) cmH2O,postoperative fell to (4.3 ±0.9) cmH2O,inserting a stent and imaging collateral vein after fully or partially disappear,the SCVS in postoperative symptoms immediately after 3 to 5 days completely disappeared.After follow-up study for 6 months to 2 years, venous cavity in all cases didn' t have obstruction of recurrence.Conclusion Multipath vena cava stent implantation has good features of small trauma,quick recovery,symptoms,and is good for malignant tumor obstruction caused by the SVCS effective minimally invasive palliative treatment.%目的 探讨采用介入方法治疗良恶性肿瘤所致上腔静脉阻塞综合征的临床疗效及应用体会.方法 38例良恶性肿瘤所致上腔静脉阻塞综合征患者中,病理证实为恶性肿瘤30例,纵隔良性占位8例;38例患者均先行右侧股静脉入路,以多侧孔直导管于狭窄段近端或远端造影,测压、显示狭窄部位、长度、程度,侧支循环及有无局部血栓形成等.直接置入Z形支架(COOK,USA),其中5例下入路未能通过狭窄段而改由经颈静脉人路.结果 38例全部开通成功,手术成功率100％,狭窄段长度3～8cm,平均长度(5.12±1.67) cm.开通前后梗阻远侧卧位测静脉压,术前(28.1±1.5) cmH2O,术后降至(4.3±0.9) cmH2O,置入支架后造影示侧支静脉完全或部分消失,上腔静脉阻塞症状于术后即刻至术后3～5d完全消退,随访6个月～2年,所有病例上腔静脉阻塞症状未再复发.结论 多路径上腔静脉支架植入术创伤小,恢复快、疗效确切,是治疗良恶性肿瘤所致上腔静脉阻塞综合征有效的微创的姑息性治疗方法.