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目的探讨上腔静脉(SVC)置换或成形术治疗胸部恶性肿瘤侵及SVC患者的手术技术选择和麻醉管理特点。方法2000年1月至2006年10月行SVC成形或置换术治疗胸部恶性肿瘤侵及SVC患者73例,其中行肺切除(含支气管成形术)+SVC成形/置换术42例;纵隔肿瘤切除+SVC成形/置换31例。直接修复21例,SVC阻断下补片修补22例,腔内引流技术下补片修补15例;人造血管置换15例。结果手术死亡3例。术后所有患者SVC梗阻症状于24～48h内明显缓解,未见脑部损害及严重并发症。随访6～42个月,随访率78.57%,3个月后再发SVC梗阻症状患者1例;1年和2年生存率分别为74.55%和58.19%。结论肿瘤侵及SVC给外科手术带来一定的难度和风险,合理恰当的外科手术技术和麻醉管理可保障SVC重建术安全实施,改善患者生存质量,延长生存时间。
Objective To investigate the surgical technique selection and anesthetic management characteristics of superior vena cava (SVC) replacement or resection for the treatment of thoracic malignant tumors invading SVC patients. Methods From January 2000 to October 2006, 73 cases of thoracic malignancies invading SVC were treated with SVC remodeling or replacement. Among them, lung resection (including bronchoplasty) + SVC shaping/replacement was performed in 42 cases; mediastinal tumor resection was performed. SVC forming/replacement in 31 cases. Twenty-one patients were directly repaired, 22 underwent patch repair under SVC blockade, 15 under patch drainage technique, and 15 under artificial blood vessel replacement. Results 3 patients died after surgery. All patients after SVC obstruction symptoms within 24 ~ 48h significantly relieved, no brain damage and serious complications. Follow-up was 6 to 42 months. The follow-up rate was 78.57%. One patient with SVC obstruction symptoms 3 months later. The 1-year and 2-year survival rates were 74.55% and 58.19%, respectively. Conclusion The tumor invading SVC brings certain difficulty and risk to the surgery. Reasonable and appropriate surgical technique and anesthesia management can guarantee the safe implementation of SVC reconstruction, improve the quality of life of patients, and prolong survival time.