Gomes M N, Hufnagel C A
Ann Thorac Surg. 1975 Sep;20(3):344-59. doi: 10.1016/s0003-4975(10)64229-4.
A review of the literature shows an increaseing number of cases of superior vena cava obstruction associated with malignancy and a marked decrease in the number of patients with caval obstruction of benign origin. In contrast to granulomatous diseases and aneurysms of the ascending thoracic aorta, which have decreased, the incidence of benign tumors is essentially unchanged. Clinical features of superior vena cava obstruction in relation to the anatomical site of obstruction and collateral pathways are correlated. Diagnostic approaches, including angiography and technetium scanning are usually definitive in outlining the site of obstruction. Experimental data and the numerous available techniques for surgical correction indicate that an entirely satisfactory procedure is not available for all patients. Methods include the use of venous bypass or Teflon prostheses and the addition of a small arteriovenous fistula proximally. Two new cases of superior caval obstruction due to benign tumor are reported. In 1 patient, who had intrapericardial bronchogenic cyst with fibrotic caval obstruction and thrombosis, a method for caval reconstruction while maintaining venous return to the right atrium is described. The second patient had an intrathoracic thyroid adenoma and caval obstruction without thrombosis.
文献综述显示，与恶性肿瘤相关的上腔静脉阻塞病例数量不断增加，而良性起源的腔静脉阻塞患者数量显著减少。与已经减少的肉芽肿性疾病和升主动脉瘤形成对比的是，良性肿瘤的发病率基本未变。上腔静脉阻塞的临床特征与阻塞的解剖部位及侧支循环途径相关。包括血管造影和锝扫描在内的诊断方法通常能明确阻塞部位。实验数据以及众多可用的手术矫正技术表明，并非所有患者都能获得完全令人满意的手术方法。方法包括使用静脉旁路或聚四氟乙烯假体，并在近端增加一个小动静脉瘘。报告了两例因良性肿瘤导致上腔静脉阻塞的新病例。在1例患有心包内支气管源性囊肿伴纤维化腔静脉阻塞和血栓形成的患者中，描述了一种在维持静脉血回流至右心房的同时进行腔静脉重建的方法。第二例患者患有胸内甲状腺腺瘤和腔静脉阻塞但无血栓形成。
