Department of Thoracic Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China.
International Medical Examination Center, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
Thorac Cardiovasc Surg. 2021 Mar;69(2):165-172. doi: 10.1055/s-0039-3401044. Epub 2020 Jan 31.
This study aimed to report our experience in superior vena cava (SVC) resection and reconstruction for 22 thymic tumor patients and to make comparisons with previous related reports.
A retrospective study on 22 patients (15 thymomas, 7 thymic cancers) who underwent tumor resection with concomitant SVC reconstruction. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. The corresponding data were reviewed, including clinical presentation, operation management (surgery procedure, selection of suitable graft, strategies against SVC syndrome, etc.), postoperative cares (antithrombotic agent application, treatments on brain edema, etc.), and follow-up information.
Two patients were myasthenic, well controlled by oral pyridostigmine. All resections were radical (R0). Ten patients received induction treatment. All the 15 thymoma patients were Masaoka stage III (type B1-B3). As for thymic cancer, six patients were Masaoka stage III and one was stage IVa. Wedge pulmonary resection was performed in three patients (two right upper lobe, one both upper lobe). Procedures included were single graft replacement in 12 patients, bilateral grafts in 9, and Y-shaped graft in 1 patient. Anticoagulation and dehydration agents were routinely applied after operation. No perioperative mortalities were observed. Major complication rate was 9.1%. The median survival time was 44.2 months (range, 4-92 months). Three- and 5-year overall survival rates were 80.8 and 44.0%, respectively. As for conduit patency, two grafts (9.1%) demonstrated evidence of occlusion during long-term follow-up, but no additional interventions were required due to no complications related.
Our study, confirming data from existing literature, showed that the prosthetic reconstruction of the SVC system is a feasible additional procedure during resection of thymic tumor infiltrating the venous mediastinal axis, minimally increasing postoperative complications in experienced hands.
本研究旨在报告我们对 22 例胸腺瘤患者行上腔静脉（SVC）切除和重建的经验，并与以往相关报道进行比较。
回顾性分析 22 例（15 例胸腺瘤，7 例胸腺癌）接受肿瘤切除联合 SVC 重建的患者。所有患者均采用血管导管交叉夹闭技术重建血管。回顾性分析其临床资料、手术管理（手术过程、合适移植物的选择、SVC 综合征的防治策略等）、术后护理（抗凝药物的应用、脑水肿的治疗等）及随访信息。
2 例患者为肌无力，口服吡啶斯的明控制良好。所有切除均为根治性（R0）。10 例患者接受了诱导治疗。15 例胸腺瘤患者均为 Masaoka Ⅲ期（B1-B3 型）。7 例胸腺癌患者中，6 例为 Masaoka Ⅲ期，1 例为Ⅳa 期。3 例患者行楔形肺切除术（2 例右肺上叶，1 例双肺上叶）。手术方式包括 12 例单移植物置换、9 例双移植物置换和 1 例 Y 形移植物置换。术后常规应用抗凝和脱水药物。无围手术期死亡。主要并发症发生率为 9.1%。中位生存时间为 44.2 个月（4-92 个月）。3 年和 5 年总生存率分别为 80.8%和 44.0%。在长期随访中，2 例移植物（9.1%）显示闭塞证据，但由于无相关并发症，无需进一步干预。
本研究证实了既往文献的数据，表明在经验丰富的医生手中，胸腺瘤侵犯静脉纵隔轴时，重建 SVC 系统是一种可行的附加手术，可使术后并发症发生率略有增加。
