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术前三维计算机断层扫描支气管造影和血管造影引导下的上腔静脉全重建。

Total superior vena cava reconstruction guided by preoperative three-dimensional (3D)-computed tomography bronchography and angiography.

作者信息

Zhang Zhenyang, Lin Jiangbo, Chai Tianci, Kang Mingqiang, Chen Wenhua, Qiu Hanfan, Zou Zhiqiang, Gao Lei, Yang Chuangcai, Zhu Jiafu

机构信息

Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.

Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China.

出版信息

Transl Cancer Res. 2020 Sep;9(9):5411-5417. doi: 10.21037/tcr-19-2249.

DOI:10.21037/tcr-19-2249
PMID:35117906
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8797622/
Abstract

BACKGROUND

The treatment of superior vena cava syndrome caused by invasive thymoma is challenging. This paper aims to explore the application of preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) for total superior vena cava reconstruction.

METHODS

Total superior vena cava reconstruction guided by preoperative 3D-CTBA in the treatment of superior vena cava syndrome offers more accurate surgical evaluation and more effective procedure of multidisciplinary team (MDT), assists radical dissection and vascular reconstruction as planed in the way of "Step by Step". It also makes the follow-up procedure more effective.

RESULTS

High-quality thoracic computed tomography (CT) image is essential. A medical team ensures procedural success with 3D-CTBA. Using this approach, five patients have been treated successfully. The average operative length was 324 minutes and the average blood loss was 190 mL. There was no surgical mortality. Five patients are alive.

CONCLUSIONS

Total superior vena cava reconstruction guided by preoperative 3D-CTBA is an effective technology for radical resection of mediastinal lesions combined with artificial vascular replacement. Meanwhile, 3D-CTBA improves the efficiency of MDT and surgical planning. It contributes to alleviate symptoms of SVCS and improve the quality of postoperative life.

摘要

背景

侵袭性胸腺瘤所致上腔静脉综合征的治疗具有挑战性。本文旨在探讨术前三维计算机断层扫描支气管造影和血管造影（3D-CTBA）在上腔静脉全重建中的应用。

方法

术前3D-CTBA引导下的上腔静脉全重建在治疗上腔静脉综合征时能提供更准确的手术评估以及更有效的多学科团队（MDT）流程，以“逐步推进”的方式辅助按计划进行根治性切除和血管重建。这也使后续流程更有效。

结果

高质量的胸部计算机断层扫描（CT）图像至关重要。一个医疗团队通过3D-CTBA确保了手术成功。采用这种方法，5例患者已成功接受治疗。平均手术时长为324分钟，平均失血量为190毫升。无手术死亡病例。5例患者均存活。

结论

术前3D-CTBA引导下的上腔静脉全重建是一种结合人工血管置换根治纵隔病变的有效技术。同时，3D-CTBA提高了MDT和手术规划的效率。它有助于缓解上腔静脉综合征的症状并提高术后生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/c3409fa5ca4c/tcr-09-09-5411-f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/08845a764179/tcr-09-09-5411-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/15cabed80c8b/tcr-09-09-5411-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/02138f389562/tcr-09-09-5411-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/c5c737ec9091/tcr-09-09-5411-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/691a8de06263/tcr-09-09-5411-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/c3409fa5ca4c/tcr-09-09-5411-f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/08845a764179/tcr-09-09-5411-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/15cabed80c8b/tcr-09-09-5411-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/02138f389562/tcr-09-09-5411-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/c5c737ec9091/tcr-09-09-5411-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/691a8de06263/tcr-09-09-5411-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/61f1/8797622/c3409fa5ca4c/tcr-09-09-5411-f6.jpg

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本文引用的文献

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Superior Vena Cava Replacement for Thymic Malignancies.上腔静脉置换治疗胸腺癌。
Ann Thorac Surg. 2019 Feb;107(2):386-392. doi: 10.1016/j.athoracsur.2018.08.060. Epub 2018 Oct 11.
2
Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases.侵袭性胸腺瘤纵隔血管重建：25例回顾性分析
J Thorac Dis. 2017 Mar;9(3):725-733. doi: 10.21037/jtd.2017.03.03.
3
Surgical outcomes after superior vena cava reconstruction with expanded polytetrafluoroethylene grafts.使用膨体聚四氟乙烯移植物进行上腔静脉重建后的手术结果。
Ann Thorac Cardiovasc Surg. 2014;20(4):310-5. doi: 10.5761/atcs.oa.13-00050. Epub 2013 Jun 4.
4
Reconstruction of the superior vena cava by biologic conduit: assessment of long-term patency by magnetic resonance imaging.生物管道重建上腔静脉：磁共振成像评估长期通畅性。
Ann Thorac Surg. 2013 Sep;96(3):1039-45. doi: 10.1016/j.athoracsur.2013.04.062. Epub 2013 Jun 21.
5
Three-dimensional imaging navigation during a lung segmentectomy using an iPad.使用 iPad 进行肺段切除术的三维成像导航。
Eur J Cardiothorac Surg. 2012 Apr;41(4):893-7. doi: 10.1093/ejcts/ezr127. Epub 2012 Jan 18.
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Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases.三维多排螺旋 CT 模拟解剖性胸腔镜肺段切除术：52 例连续病例报告。
J Thorac Cardiovasc Surg. 2011 Mar;141(3):678-82. doi: 10.1016/j.jtcvs.2010.08.027. Epub 2010 Sep 29.