Dartevelle P G, Chapelier A R, Pastorino U, Corbi P, Lenot B, Cerrina J, Bavoux E A, Verley J M, Neveux J Y
Department of Thoracic and Vascular Surgery, Hopital Marie Lannelongue, Plessis Robinson, France.
J Thorac Cardiovasc Surg. 1991 Aug;102(2):259-65.
The contraindication to curative excision of mediastinal and pulmonary cancers because of invasion of the superior vena cava is now challenged by the existence of vascular prostheses that are suitable for venous replacement. Between 1979 and 1990 22 patients underwent resection of lung cancer (n = 6) or malignant mediastinal tumors (n = 16) involving the superior vena cava. Resection was done with concomitant venous reconstruction, and polytetrafluorethylene grafts were used. All bronchogenic carcinomas necessitated right pneumonectomy, whereas the excision of mediastinal tumors had to include pulmonary resections in nine patients (five lobectomies and four sublobar resections) and the right phrenic nerve in 12 patients. Venous reconstruction was performed by interposition of a large polytetrafluoroethylene graft between the proximal and cardiac ends of the superior vena cava (n = 8), or between one (n = 10) or both brachiocephalic veins (n = 4) and the right atrium. One patient died postoperatively (4.5%), and another had mediastinitis that was successfully treated by omentopexy. Chemotherapy was administered preoperatively to five patients and postoperatively to seven patients; radiotherapy was administered to two and 10 patients, respectively. The overall actuarial survival rate is 48% at 5 years, with 11 patients presently alive. The survival rate of patients with mediastinal tumors is 60% at 5 years. Among the patients with lung cancer, two with N1 disease are alive at 16 and 51 months, and one died at 38 months; the two patients with N2 disease died at 6 and 8 months. Only one graft occlusion occurred in the postoperative period; another occurred 14 months after operation and was precipitated by insertion of a central venous catheter. The patency of all remaining grafts was demonstrated after an average time of 23 (1 to 98) months. On the basis of these results, polytetrafluoroethylene graft replacement of the superior vena cava should be part of the planning and execution of radical excision with curative intent of mediastinal and right pulmonary malignant tumors that are not present with other contraindications, such as pleural or distant metastasis and severe systemic disease.
由于上腔静脉受侵而导致纵隔和肺癌无法进行根治性切除的情况，如今因适用于静脉置换的血管假体的出现而受到挑战。1979年至1990年间，22例患者接受了涉及上腔静脉的肺癌（n = 6）或恶性纵隔肿瘤（n = 16）切除术。手术中进行了静脉重建，并使用了聚四氟乙烯移植物。所有支气管源性癌均需行右肺切除术，而纵隔肿瘤切除术在9例患者中不得不包括肺切除术（5例肺叶切除术和4例肺叶下切除术），12例患者中还不得不切除右膈神经。静脉重建是通过在上腔静脉近端与心脏端之间（n = 8），或在一条（n = 10）或两条头臂静脉（n = 4）与右心房之间插入一段大型聚四氟乙烯移植物来完成的。1例患者术后死亡（4.5%），另1例发生纵隔炎，经网膜固定术成功治疗。5例患者术前接受化疗，7例患者术后接受化疗；分别有2例和10例患者接受放疗。5年总精算生存率为48%，目前有11例患者存活。纵隔肿瘤患者5年生存率为60%。在肺癌患者中，2例N1期患者分别在16个月和51个月时存活，1例在38个月时死亡；2例N2期患者分别在6个月和8个月时死亡。术后仅发生1例移植物闭塞；另1例在术后14个月发生，是由于插入中心静脉导管所致。所有其余移植物在平均23（1至98）个月后显示通畅。基于这些结果，对于不存在其他禁忌证（如胸膜或远处转移以及严重全身性疾病）的纵隔和右肺恶性肿瘤，聚四氟乙烯移植物置换上腔静脉应成为根治性切除计划和实施的一部分。
