Zhang F, Wu P, Huang J
Department of Imaging and Intervention, Cancer Center, Sun Yat-sen University of Medical Sciences, Guangzhou 510060, China.
Zhonghua Zhong Liu Za Zhi. 2000 Nov;22(6):507-9.
To study the therapentic efficacy of using intravascular stent and local thrombolysis for superior vena cava syndrome(SVCS) in cancer patients.
Among 26 cancer patients with SVCS there were 17 cases of lung cancer with mediastinal lymphnode metastases, 5 cases of malignant mediastinal tumor, 2 cases of non-Hodgkin's lymphomas, 2 cases of esophageal carcinoma with mediastinal lymphnode metastases. Through femoral vein, a catheter with side holes was introduced up to the superior vena cava. Following local dripping of urokinase for 20-40 min, the obstructed region was distended with the inflated balloon and then a self-expanding stent was put in the inflated region.
The procedure was successful in 24 patients, but failed in 2 cases because the guide wire could not pass through the obstructed region. In 3 patients with superior vena cava stenosis of 10 cm in length, two stents were used. In the other 21 patients, 1 stent was adequate. Local thrombolytic treatment was given in 24 patients before the angioplastic balloon was inflated. The vena caval pressure at the distal end of the stenotic lesion dropped from 21.23 +/- 1.80 mm Hg before treatment to 5.33 +/- 0.98 mm Hg after treatment. The difference was statistically significant. Collateral veins were no longer filled by contrast after treatment. The caliber of the supericar vena cava restored to normal and its outline was smooth. The symptoms of SVCS subsided after treatment in 2-3 days.
Intravascular, self-expandable stent combined with local thrombolysis is a micro-invasive and effective method of treatment for cancer patients with superior vena cava syndrome.
研究血管内支架置入联合局部溶栓治疗癌症患者上腔静脉综合征（SVCS）的疗效。
26例患有SVCS的癌症患者中，17例为伴有纵隔淋巴结转移的肺癌，5例为恶性纵隔肿瘤，2例为非霍奇金淋巴瘤，2例为伴有纵隔淋巴结转移的食管癌。经股静脉插入一根带侧孔的导管至 Superior vena cava。局部滴注尿激酶20 - 40分钟后，用膨胀的球囊扩张阻塞区域，然后在扩张区域置入自膨式支架。
24例手术成功，2例失败，原因是导丝无法通过阻塞区域。3例上腔静脉狭窄长度为10 cm的患者使用了两个支架。其他21例患者，一个支架就足够了。24例患者在血管成形球囊扩张前进行了局部溶栓治疗。狭窄病变远端的腔静脉压力从治疗前的21.23 +/- 1.80 mmHg降至治疗后的5.33 +/- 0.98 mmHg。差异具有统计学意义。治疗后造影剂不再充盈侧支静脉。上腔静脉管径恢复正常，轮廓光滑。SVCS症状在治疗后2 - 3天消退。
血管内自膨式支架联合局部溶栓是治疗癌症患者上腔静脉综合征的一种微创且有效的方法。
