Department of Cardiothoracic Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 215, Indianapolis, IN 46204, USA.
Ann Thorac Surg. 2010 Aug;90(2):383-7. doi: 10.1016/j.athoracsur.2010.04.004.
Resection and reconstruction of the superior vena cava (SVC) is occasionally required in the surgical treatment of intrathoracic neoplasms or symptomatic occlusion secondary to benign causes. We reviewed our institutional experience with SVC reconstruction using externally stented-polytetrafluoroethylene vascular prostheses.
From 1991 to 2009, medical records of 38 patients who underwent SVC resection and reconstruction with externally stented-polytetrafluoroethylene vascular prostheses were reviewed. Indications for surgery were malignancy in 34 (89%) patients (germ cell, 13; thymoma, 10; lung cancer, 9; sarcoma, 2) and benign symptomatic occlusion in 4 (11%) patients.
Eighteen patients (47%) underwent right innominate vein to SVC interposition graft reconstruction, which became the favored approach during the study interval when resection of the innominate confluence was necessary. Eight patients (21%) had left innominate vein to SVC interposition grafts, earlier in the series or when the right innominate vein was unavailable. Nine patients (24%) received graft interposition of the proximal to distal SVC. The remaining 3 patients had a Y reconstruction. There were 2 perioperative mortalities. Follow-up averaged 15 months (range, 1 to 113 months), including 11 (29%) patients who died of disease. All patients demonstrated minimal to no brachiocephalic swelling at last follow-up. Twenty (53%) patients underwent imaging after an average of 24 months (range, 1 to 113 months) with only two grafts demonstrating complete occlusion.
Although several SVC reconstructive techniques have been described, externally stented-polytetrafluoroethylene vascular prostheses are readily available for off-the-shelf use. In our experience, patency rates are high, and patients who do demonstrate graft thrombosis have minimal to no symptoms.
在胸内肿瘤的外科治疗或因良性原因导致的症状性阻塞中，有时需要切除和重建上腔静脉（SVC）。我们回顾了使用外部支架聚四氟乙烯血管假体进行 SVC 重建的机构经验。
从 1991 年到 2009 年，对 38 例接受 SVC 切除和重建的患者的医疗记录进行了回顾，这些患者使用外部支架聚四氟乙烯血管假体。手术指征为 34 例（89%）患者的恶性肿瘤（生殖细胞瘤 13 例；胸腺瘤 10 例；肺癌 9 例；肉瘤 2 例）和 4 例（11%）患者的良性症状性阻塞。
18 例（47%）患者行右无名静脉至 SVC 间置移植重建，当需要切除无名汇合处时，该方法成为研究期间的首选方法。8 例（21%）患者行左无名静脉至 SVC 间置移植，手术时间较早，或右无名静脉不可用时。9 例（24%）患者接受了 SVC 近-远段移植物间置。其余 3 例患者进行了 Y 型重建。有 2 例围手术期死亡。平均随访时间为 15 个月（范围为 1 至 113 个月），包括 11 例（29%）死于疾病的患者。最后一次随访时，所有患者均表现为最小至无头臂肿胀。20 例（53%）患者在平均 24 个月（范围为 1 至 113 个月）后进行了影像学检查，仅发现 2 例移植物完全闭塞。
尽管已经描述了几种 SVC 重建技术，但外部支架聚四氟乙烯血管假体可随时用于现货使用。根据我们的经验，通畅率较高，并且确实发生移植物血栓形成的患者症状最小或无症状。
