Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
Ann Thorac Surg. 2010 Jul;90(1):223-8. doi: 10.1016/j.athoracsur.2010.03.050.
This retrospective study investigated long-term graft patency and outcomes for malignant diseases with invasion of the superior vena cava (SVC).
From October 1995 to November 2008, 20 patients underwent combined surgical resection of malignant tumors and the SVC with vascular reconstruction using a ringed polytetrafluoroethylene graft (8 to 12 mm) Sigmoid-curved spatulation of the graft end at the right auricle was performed to obtain a wide orifice left graft. Anticoagulation therapy was routinely administered for 3 to 6 months. Postoperative graft patency was verified at 2 to 4 weeks, 3 months, and after 12 months. Indications were lung cancer in 9 patients, thymic tumors in 8, germ cell tumors in 2, and thyroid cancer in 1.
Procedures were single graft replacement in 9 patients, bilateral grafts in 10, and bilateral SVC grafts and 1 pulmonary artery graft in 1. All grafts were patent over a short-term period, but 1 limb of the bilateral grafts became occluded in 2 patients who received bilateral grafts during long-term follow-up. Bronchial dehiscence after lung cancer resection caused 1 in-hospital death. Mean follow-up was 44.7 months. Median survival was 22.1 months. Overall survival was 66.4% and 41.5% at 1 and 5 years, respectively. Survival for lung cancer was significantly worse at 5 years (62.5%) than thymic tumor (18.8%, p = 0.04).
Prosthetic reconstruction of the SVC for anterior mediastinal tumors and lung cancer is feasible. Reconstruction of the SVC using a single left graft to avoid total cross-clamping of the SVC is effective.
本回顾性研究调查了侵犯上腔静脉（SVC）的恶性肿瘤的长期移植物通畅率和结局。
1995 年 10 月至 2008 年 11 月，20 例患者接受了恶性肿瘤的联合切除术和 SVC 切除术，并使用带环的聚四氟乙烯移植物（8 至 12mm）进行血管重建。在右耳进行移植物末端的 S 形曲线斜切，以获得宽大的左移植物口。常规给予抗凝治疗 3 至 6 个月。术后 2 至 4 周、3 个月和 12 个月时确认移植物通畅性。9 例患者为肺癌，8 例为胸腺瘤，2 例为生殖细胞肿瘤，1 例为甲状腺癌。
9 例患者行单根移植物置换，10 例患者行双侧移植物置换，1 例患者行双侧 SVC 移植物置换和 1 例肺动脉移植物置换。所有移植物在短期内均保持通畅，但在长期随访中，2 例接受双侧移植物置换的患者中，其中 1 侧移植物出现闭塞。肺癌切除后支气管破裂导致 1 例院内死亡。平均随访时间为 44.7 个月。中位生存时间为 22.1 个月。总生存率分别为 66.4%和 41.5%，1 年和 5 年。肺癌的 5 年生存率（62.5%）明显低于胸腺瘤（18.8%，p=0.04）。
前纵隔肿瘤和肺癌的 SVC 假体重建是可行的。使用单根左移植物重建 SVC 以避免 SVC 完全阻断是有效的。
