上腔静脉阻塞综合征的血管内支架治疗

上腔静脉阻塞综合征的血管内支架治疗

官泳松 汪小舟 黄明亮 张华山

华西医科大学附属第一医院放射科

四川省眉山县人民医院介入放射科

[摘要]

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例上腔静脉综合征患者，原发病灶均由病理组织学诊断为恶

性肿瘤。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

15.7cmH2O，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。

[关键词]上腔静脉综合征 肿瘤 支架 影像诊断 介入治疗 Abstract Purpose: To study the techniques and clinical applications in the therapy of Superior Vana Cava Obliteration Syndrome(SVS) by intra-vascular stenting. Method: 9

cases of SVS. Primary lesions were all confirmed as malignant with histological pathology. By route of right femoral vein, we made SVS catheterization and DSA. Lengths of strictures were measured as well as diameters of normal Superior Vana Cavae (SVC) 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 1-2cm 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 with fluoroscopy or chest films, and about patency of SVC with Doppler. Result: After the placement of a stent, SVCs were revealed with DSA as contrast media passing along smoothly, diameters of SVCs almost normal, collateral branches diminished remarkably. Average SVC pressure decreased from 26.4cmH2O before the placement down to 15.7cmH2O, with an obvious difference (ρ＜0.01) by statistics. Related clinical symptoms and signs disappeared or relieved. Resided 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 worthy promoting with its mild traumatizing, easiness and effectiveness.

Key Words: Superior Vana Cava Syndrome Tumor Stent Image Diagnosis Therapeutic Intervention 上腔静脉阻塞综合征在晚期肺癌患者常见。我们应用介入放射学方法行血管内支架置入术，取得了较好的疗效，现总结如下：

1 材料与方法

1.1 一般资料 本组9例，男7例，女2例，年龄38—74岁，平均56.4岁，全部病例均有胸片、CT或MRI、纤支镜及病理组织学诊断依据。2例系外科手术后复发转移，5例同时行支气管动脉灌注化疗。全部病例都有头颈部、双上肢及胸壁软组织肿胀，浅静脉曲张。1例曾发生昏迷，6例有胸腔积液。下腔静脉引流区无软组织肿胀及静脉曲张，血浆白蛋白在正常范围。

1.2 设备和特殊器材 使用美国GE公司DSA血管造影机。器材有亲水型及珠头导丝，5F或4F Corbra导管，直猪尾造影导管，选用Symphony nitinol 或SMART或Gianturco Z型或Easy Walstent自膨式金属支架。