[doc格式] 恶性肿瘤所致上腔静脉压迫综合征的介入治疗

[doc格式] 恶性肿瘤所致上腔静脉压迫综合征的介入治疗 恶性肿瘤所致上腔静脉压迫综合征的介入 治疗 3( ?7???j???7???<???v???j?????;??,?7??V?116023) V?V?Vn????VBV?????V????????9???????????????7???;?/???W?????8?j?????)???????E???M???e??V,V?????V?13?????7???; ?/???W?????8?j?????)?????0?T,?????M??????????????8??,????????????????????2??,???????7???;2??,?????????? ??????????1??,?G???????????2?????b???7V,???????????8????,???I?z???????????????????f?????m??,?t??????????V( ????V(?a??,???/???/?S???n?0????????Wallstent?p??(BostonScientific,USA),1???l??????Z???p??(COOK,USA),?)???/ ?S???????????S?????/?????S?t???????p??V,V?????V?13?????????C?n??,???p?n????100%,?????????G????4.3cm(3?? 6cm)V,1??????2???p??,???????0?G????1???p??V,6???9?p?????????????S????V,???C???t???j?????????????8??,?p ??(26.2??1.6)cmH2O,?p?t????(4.3??0.8)cmH2O,?????p???t?m???b???p???8???????y,?W?????8?j?????????p?t???j ???p?t3d????????V,8???p?t4??10?I?)?????????;?C?6?????m?n?e??????????,????5??(?0???t????????3??)???j,?? ??8??26?I?),?T????13?I?),?/?8?????W?????8?j???????I???s??V,V?????V??W?????8?p?????????2???)?????/?????S?? ???p???7???;?/???W?????8?j?????)???8?E?????O????????V, Vn???u??VBV??W?????8???)??;V????7???;;V????p??;V????S???? V?V??T???2????:R73;R543V?V?V?V????u?3??:AV?V?V?V??????f??:1009-6604(2008)04-0355-05 InterventionalTreatmentforSuperiorVenaCavaSyndromewithMalignantCausesV?SongLei 3 ,WangFeng,JiDonghua,et al. 3 DepartmentofOncology,SecondAffiliatedHospitalofDalianMedicalUniversity,Dalian116023,China VnAbstractVBV?ObjectiveV?Toevaluatetheefficacyandclinicalvalueofpercutaneoustransluminalangioplasty(PTA)with stentingforthetreatmentofsuperiorvanacavasyndrome(SVCS)withmalignantcauses.V?MethodsV?Atotalof13patientswith SVCSwithmalignantcauseswereenrolledinthisstudy.Amongthepatients,2hadmediastinalcancer,and11hadmetastatic mediastinaltumor.Themalignancyoftheprimarytumorsofthe11patients,includingpulmonarycancerin8,esophagealcancerin2, andbreastcancerin1,wereallconfirmedbypathologicalexamination.Viatherightfemoralvein,apigtailcatheterwasintroduced percutaneouslyintotheproximateorremoteendofthestenoticsegmentforthevisualizationoftheSVC.Afterthelocation,length,and gravityofthestenosisweredetermined,Wallstent(BostonScientific,USA)wasplacedintotheSCV,ifthepatientshadnolocal thrombosisinthestenoticsegment.Inonepatient,aZ2shapestent(COOK,USA)wasinsertedsimultaneously.Forthecases complicatedwiththrombosis,theWallstentwasinsertedafterlocalthrombolysis.V?ResultsV?Theprocedurewascompletedinallthe13 patientswithasuccessrateof100%.Theaveragelengthofthestenoticsegmentwas4.3cm(3-6cm).Inonepatient,twostents wereused,whileintheothersonlyonestentwasinserted.Thrombolysiswascarriedoutbeforestentingin6patients.Theintravenous pressureattheproximateendofthestenoticsegmentwasdeterminedwiththepatientssupinebeforeandafterstenting.Thepressure decreasedfrom(26.2??1.6)cmH2Oto(4.3??0.8)cmH2Oaftertheoperation.Postoperativeangiographyshowednocollateralvein inthepatients.TheSCVSdisappeared0to3daysafterthesurgery.Thepatientswerefollowedupfor8-26monthswithamedianof 13.Duringthisperiod,8patientsdiedofmultipleorganfailurecausedbymultiplemetastasisoftheprimarytumorin4to10months; theother5patientssurvived(3ofthemreceivedfurthertherapies)withoutrecurrenceofSCVS.V?ConclusionV?PTAwithstenting combinedwithlocalthrombosisisaneffectiveandinvasivetreatmentforpatientswithSCVSwithmalignantcauses. VnKeyWordsVBV?Superiorvenacavasyndrome;V?Malignanttumor;V?Intravascularstent;V?Thrombolysis V?V??W?????8???????)??(superiorvenacava syndrome,SVCS)?p?y???W?????8????????V(?j???/ ?????????M????????,?C???b???;????V(?????W???? ?8?/??,?M???W?C?E?:?7?f???:?7???;????,???s?? ?????8?E?????M??????,?Z?C?????.??V,?m?????? ?????????z??V(?f?????E??,?f?????p???????p?.?? ??553???T?????O?f???>??2008??4?)?v8???v4?.V?ChinJMinInvSurg,April2008,Vol.8.No.4 ;?(?7???j???7???<???v???j????????,?7??V?6) 31 1020 ,?W ?????8?p???n???p???W?????8?/?????????S?p,?? ???7???2?y?????7???;?i????SVCS?????????V?? ??V,2003??11?)??2006??10?),?B????13??(?7 ???j???7???<???v???j??6??,?7???j???7???<?? ?v???j??7??)???7???;?/???W?????8?j?????)?? ??????????????,?G???n??,???????aV, 1V??M???<???t???? 1.1V????v?<?? ?v??13??,?F11??,??2??V,????38??70??, ???G48??V,?G?8????V(??????????,???????8?z?w, ?????8?o?m,3???M?t?z????V(?c??V(?????.,?s???? ??,?????????????/?E???r??V,?????????V?????? ?p????5?-??1?I?)V,???e????????(non2smallcell lungcancer,NSCLC)?M??????????????8??,???T3 ???????????D???7?z??,2????NP(???:???????) ????)???E?????f??,3???%??;???????????????? ??????2??,???????;???b?D???7?z??;???7?????; 2??,?????????W?????8,?y???D?????p?b?C;???? ????????????????1??,??????TA(?r???????)?C ?????.)V(NP???E?C???.?????f??V,???W???0??5 ??(3?????e????????,2?????7?????;)?b?%??,?G ?b???????????E,???;?????????W?????8????V, ?p????CT????????,?????????W?????8???? ????V,?/?J???????/????????,?????/?e???????? ???/????,??????V(???S??????V,CT?z?b?W?????8 ????????,8???????????M?????8?G?)?????a,???? ?????N????2cm???W,5???p???G?)??,?p?T?W?? ???8?m????????????V, 1.2V????? 1.2.1V??W?????8?m??V??G???9?????8????,???b?n ???t,???%?i???a?(??Pigtail???????W?????8???? ???????m??,?t???W?????8??????????V(?a??V(????, ?p?R?)???/???/?S???n,???p????????????,?????? ?????;??????V, 1.2.2V????????/?????S?pV?6???/???)???/?S?0, ??????100cm??Mewissen???S????(Boston Scientific,USA)???/?S?????N?????(?????S???e?? 2000??4000U/kg,?l???9???????/????(???j?f?? ?2???/?j?????????(?9???J?P??1.5??2.5?s,???? ???????s????0.2g/dl)?????a?????m??????????, 24?e???t?s???m???t???/?S????????V, 1.2.3V??W?????8?p???????pV??/??????>70%?f ?;????????>5cmH2O(1cmH2O=0.098kPa),?; ???????????????M???????S???8?e??,?p?T?????? ???p??????????(??);?)???/?S???n????,???[?2 ???????/?????S?????t,?????p?????????????? (??2)V,?p???????W?????8?j??V(???f?????M???? ?8V,?v?????9Wallstent?p??(BostonScientific, USA),????14??20mm,????6??10cmV,1???l?? ???91??Z???p??20mm??50mm(COOK,USA)V, ?p?t???j???/???m???????/?????C????,?????p?R ?????1?????m(?1??????12??18mm,????4??6 cm),?????p???;?????H?????8??V, 1.2.4V??p?t?6?2V??p?t3d?????????m?????8?? ??????????,?p?t3d?????s??????????????3??6 ?I?),???(???[?3???f???P(INR)2.0??3.0???1?? ??V, 2V????? ?v??13???????a???G>85%,?????7?j??8 ??,?t?z????5??,????????3??6cm,???G4.3cmV, ???T6???8?/?S???n,???[?2?????????????????S ?????t,?/?S????????3??,???2????3??(1?? 85%,2??70%),?/?S?????t??????>70%???/?? ????V,13???p?????z?????n??,1??????Wallstent ?t?p?????????z?s??,???k?????I???V?8?E????,?? ??1??Z???p???t?M?????????.?S??V,????12?? ?G?????????p??,??????13??Wallstent?p??,1?? Z???p??V,???C???t???j?????????8??,???p???? (26.2??1.6)cmH2O???V?p?t??(4.3??0.8) cmH2O,???,?8?z???7(????t????t=41.65,P< 0101)V,?p???m???z?b?7?????p????????,?p???? ???p?t?W?????8???C,?m???z?b???p???8???????yV, ?p?t?????G?t?z?D??,???????8?????????8?o?m?G ???y,?W???????????????p?t???j???p?t3d???? ???y,???????8???k???????????????????????M?? ???.V,?G?I???1??????,5???????p???t???????? 45%??50%?/??????,???1???t???mV,?p?t?s???? ?G?fCT,?p??????????,??????V,5???%???????T3 ??(1?????7?????;,2??NSCLC)?????t???????; ????,???T???7?????;????2005??11?)25?????? ?W?????8?p???n???p,?p?t?????;???b?z??,?p?t 26?I?)(?r?H?s??????CT2008??1?)23??)??V( ??V(?????????/?????;?s??,?]??SVCS????V,8?? ?p?t4??10?I?)?????????;?C?6?????m?n?e?????? ????,???W?????8?j???????s??;????5??(?0???t ????????3??)???j?0????8??26?I?),?T????13 ?I?),???W?????8?j??????????,?s?????????bCT, ?p?????z????,?????????????/?S???nV, 3V????? ???7???;?/???W?????8???????)???p?J?????; ???:??,?M????????,???????????.V,?f?????pV(?z ??V(?f???p?W?????8???????)???????J???9?????? ??653???T?????O?f???>??2008??4?)?v8???v4?.V?ChinJMinInvSurg,April2008,Vol.8.No.4 1 1V????7?????;?/??SVCSV?aV(b.V?CT???????b?????p???????M?????8?G?)??(???M?/?b)V?cV(d.V??m?????b?????M?????8?? ?G?)???????[???b??,???????7?????p???8V?V(fV????C?W?????8?j???t?????M?????8,????W?p??(8??6)?t, ???????z?s??,?9W?p???????9?l?????p????Z???p??(??5)?t,???k????????V?V(V??p???n???p?t?? ?s??????T,?p?????(???JV?V??p???n???p?t?I?),?????b?z???t3?I?),????T???b???;?-?e,?p?????(???JV?jV??p?? ?n???p?t6?I?)?s??????T,???;?h??,?p?????(???J ??753???T?????O?f???>??2008??4?)?v8???v4?.V?ChinJMinInvSurg,April2008,Vol.8.No.4 e.allstent1mm0mm allstent20mm0mmgh.20 Ci.7C. 2C 2V?SVCS?)???/?SV?a.V????????m?????b?W?????8?/????90%?/???7????,?????M?????8???????????/?S???nV?b.V??????S???????S ????,?????M?????8???/?S????,?]?W?????8????????80%????V?c.V????S?t?????????/??????Wallstent?p??(14mm??60mm),?????? ????????,?s???m?????k?C?[ ????,?]?y???????8?????????????????W???s?l,?M ?????E???,???7V,?8???u????,???????7???;?/?? ?W?????8???????)??,?????;?3?????W?????8???? ?p?????p?O?;?7,?????????????n??,?l?????????; ?3?????s???D?????0???.???.?c?O?;?7,?9?M???W ???B???9 [1] V,???????z?????p?????f?????????s ??????,???????2?z?f?????.???;?/??SVCS,???? ?????????e?????E,?]???????2?z?f???s???.???;, ?????p?????????????9???I?z?b???t?z???A?? [2] V, Rowell?? [3] ????34???????)??SVCS,?????????? ?.???>?????6(rapid2highdoseirradiation),?????? ?92.0Gy???J???2???z??,????90%???e???????? (smallcelllungcancer,SCLC)?W?????8?j???????S ???????????????.??,76%NSCLC?????S??,?] 45%NSCLC?9?.???.??SVCS?s??V,Tanigawa ?? [4] ?????????l????,?z????NSCLC?)??SVCS?? ?0???.???E?m??V,Bierdrager?? [5] ???????????c?? ????,???????????2?s?t?????7???;?/??SVCS?? ??,???z?f???????/?????p???n???p,?8???????.?S ???M??????,?????b?C??????????????????,?c???8 ?E?w???????z?f???????????????2?????/?m?n???? ??,?p????????V(????V(?8?E???8??V,?v??8?? NSCLC,???T5???????????D???7?z???f?f??,???? ?????????s??,????SVCS????,?z?f???t???????G ?S??????3?I?)V,?[?B?????b,???????????8?t?? ???2????,???????b?z?f?????.???;?/??SVCS?? ??,?????????9?z???f?f?????????????;????,???? ?C???????2??V(???.?????E;???????2???b?z?f???s ???.V(?????????2?s?t?f???????9???z??V(?f???E?? ?m???????0,?????y??????????????,?/???M?????? ??,?m?n?M??????????,???v???????f?l?y???????? ?????b?C,?????????2????,?W?????8?p???n???p?? ?????b???8??????????,?W?????8?????????C???? ?.?D???M??????,?b???????????????????????b?CV, G?? [6] ????SVS???/?????p??????, ?p???????p?t????,3?????7???;??SVS???t?? ?????;??????,???G?.???????b193dV,?b???????? ?0???.???.,?????????????????v???????? [7] V,?v ??3?????p?t?????????????????;???t???????;?? ??,5?????????????z?f???E???m??,?p?t?I?????a ?z?f??,5?????????f?v???????I?????????????? ?;????V,?????t???????;??????3???9?????.???? ?????j,?c?G??SVCS????V,???T1?????7?????; 2005??11?)25???????W?????8?p???n???p,?p?t ?????;???b?z??,???j????(?r?H?s??????CT2008 ??1?)23??),??V(??V(?????????/?????;?s??,?]?? SVCS????V,?b?w???W?????8?n???p?t?p???????. ?/?S?7????,?[?2???????f???/?e???????????p?? ???????????? [8,9] V,?v???p?t?G??????V(???????? ??????,????????3??6?I?),?G?I???.?p???/???? ???/?S???nV,?/?8?????????.???G?I????SVCS?? ???s??V,???v?????????B,?????????C??,?c?????? ?;?.?????7?s?l,?????????H?eV(???E???????0???? ?.?.?????8?A??,?C????????????????V, ?J???? [10] ???????9?y?e?V?7?????1???????? ??????????,???????p??????,???8?E???B???/???? ?????k?/???????M???????.V,?v???G?I???1???? ??,?????????p??,????????????????6?????9?,?? ?????1???????t??,?/?8?????G?I???.?[?/?7???? ????V(???M??????????V,?????v???????G?b?:?7?., ?c?????????/??????????????,?/???:?7???C?t?? ?8????????????????????V,?????)???/?S???????? ?:?7??????,???????S????,?????8???8???2???C, ???S???????2???k????,???????:?????????????? ???.V,?B?????b,?????M?????k???????????????? ??,?9?p?????C???????9?:???????/?????????a,?? ???,???>???y?M?>???????????/????,?????:?7?? ?????;?????.V, Dinkel?? [11] ????,?????M?????8?l?????p?? SVS????,???????C???f?????M?????8?t?????l?? ???C??????,?;?????E?????,V,?????p?????????8 ???p??????V(???????????BV(???.?s??????V(???(?D ??853???T?????O?f???>??2008??4?)?v8???v4?.V?ChinJMinInvSur g,April2008,Vol.8.No.4 arcia44C 2C C 5???????????G?)??,?8???????M ?????8???C,?G?????n??,?M???????????S??,???? ???????????.V, ?8???u?????W?????8?n???p???8??Gianturco ZV(WallstentV(Palmaz???p?? [12,13] ,?C?????0?j?m?9?? ???e?p??,???????9???C???pWallstent?p???? Palmaz?p?? [14] V,?v??14???p???T13???G?b Wallstent?p??,???T1??????Wallstent?t?p?????? ???z?s??,???k?????I???V?8?E????,????1??Z?? ?p???t?M?????????.?S??,?]?p?y?????????s?C,?c ?p?????9????,?/???????????s?l?p???9????SVCS ?T?????9?8???????????EV, ?W?????8?p???????p???/?????S?p????SVCS, ???8????V(?O?;?eV(???s??V(???E?z??V(?S?n??V(???? ???B??????,?,?????v?????????????0,?8?????D?? ???0???.???9??V,?/??,?????????????????????b ?7???2SVCS???0?????8????????V, ???1???u 1V?DempkeW,BehrmannC,SchoberC,etal.Diagnosticandtherapeutic managementofthesuperiorvenacavasyndrome.MedKlin,1999,94 (12):681-684. 2V?MathiasK,JagerH,WillaschekJ,etal.Interventionalradiologyin centralvenousobstructions.Dilatation2stentimplantation thrombolysis.Radiology,1998,38(7):606-613. 3V?RowellNP,GleesonFV.Steroids,radiotherapyandstentsforsuperior venacavalobstructionincarcinomaofthebronchus:asystemic review.ClinOncol,2002,14(5):338-351. 4V?TanigawaN,SawadaS,MishimaK,etal.Clinicaloutcomeofstenting insuperiorvenacavasyndromeassociatedwithmalignanttumors. 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(?L?N???.:2006-10-17) (???????.:2007-03-21) (?5???f?????b?P) ??953???T?????O?f???>??2008??4?)?v8???v4?.V?ChinJMinInvSurg,April2008,Vol.8.No.4 lithiasiswithpneumaticlithotrips:analsiso27proceduresina publichospital.roles200:422-42. :