Thoracic Surgery Department, Istituto Nazionale dei Tumori, Via Venezian 1, 20100 Milan, Italy.
Eur J Cardiothorac Surg. 2010 Apr;37(4):764-9. doi: 10.1016/j.ejcts.2009.10.024. Epub 2009 Nov 24.
After superior vena cava (SVC) resection, the need for reconstruction varies among tangential resection, pericardial patch repair and prosthetic replacement. Patients undergoing complete prosthetic replacement often require a different surgical approach, intra-operative SVC cross-clamping and anticoagulation when polytetrafluoroethylene (PTFE) prosthesis is used. This study tested the hypothesis that PTFE replacement may interfere with perioperative outcome.
Clinical records from a series of 72 consecutive SVC resections performed between 1998 and 2008 were reviewed. Complications were classed into five categories: surgical, respiratory, cardiac, SVC system thrombosis and nerve damage. Each category of postoperative complications was considered as an outcome variable in a univariate analysis testing 12 covariates as risk factors. Covariates considered clinically relevant or statistically significant were included in the multivariate model.
During the considered period, 28 patients underwent total SVC resection with PTFE prosthetic replacement and 44 patients underwent SVC repair by the use of direct running suture (nine patients), stapling (30 patients) or autologous pericardial patch (five patients). Two patients died postoperatively (2.8%). Major complications were mainly due to respiratory failure, which occurred in nine cases (acute respiratory failure in five cases, recurrent atelectasis in three cases, acute respiratory distress syndrome (ARDS) in one case). In terms of overall mortality and morbidity, univariate analysis did not confirm a detrimental effect of SVC replacement as compared with SVC repair, as major postoperative complications occurred in similar proportion in both groups (respectively, 6/28, 21.4% vs 7/44, 15.9%, p=0.54). No other risk factor was identified by univariate analysis.
Complete prosthetic replacement does not increase overall postoperative morbidity in patients undergoing SVC resection and can be safely performed when other reconstruction techniques preclude sufficient tumour-free resection margin or compromise adequate blood flow.
上腔静脉（SVC）切除后，切线切除、心包补片修复和人工假体置换的需求各不相同。完全采用人工假体置换的患者通常需要不同的手术方法、术中 SVC 阻断和聚四氟乙烯（PTFE）假体使用时的抗凝治疗。本研究检验了 PTFE 置换可能会影响围手术期结果的假设。
回顾了 1998 年至 2008 年间连续 72 例 SVC 切除术的临床记录。并发症分为五类：手术、呼吸、心脏、SVC 系统血栓形成和神经损伤。将每种术后并发症类别视为单变量分析中的一个因变量，共检测了 12 个协变量作为危险因素。将临床上认为相关或统计学上显著的协变量纳入多变量模型。
在所考虑的时期内，28 例患者接受了上腔静脉全切除和 PTFE 人工假体置换，44 例患者接受了直接连续缝合（9 例）、吻合器（30 例）或自体心包补片（5 例）修复 SVC。术后有 2 例死亡（2.8%）。主要并发症主要是由于呼吸衰竭引起的，9 例患者出现急性呼吸衰竭（5 例）、复发性肺不张（3 例）、急性呼吸窘迫综合征（ARDS）（1 例）。就总体死亡率和发病率而言，单变量分析并未证实 SVC 置换与 SVC 修复相比具有不利影响，因为两组中主要术后并发症的发生比例相似（分别为 6/28，21.4%和 7/44，15.9%，p=0.54）。单变量分析未确定其他危险因素。
在上腔静脉切除术中，完全采用人工假体置换并不会增加总体术后发病率，当其他重建技术不能提供足够的无肿瘤切除边缘或不能保证足够的血流时，可以安全地进行这种手术。
