Shepherd F A
Toronto Hospital, Ontario, Canada.
Curr Opin Oncol. 1995 Mar;7(2):150-7. doi: 10.1097/00001622-199503000-00010.
Obstruction of the superior vena cava is seldom a true emergency and should not be treated without an adequate tissue diagnosis. For patients who are poor operative risks for invasive procedures, percutaneous biopsies of mediastinal masses under ultrasound guidance have resulted in a high diagnostic yield. Superior vena caval syndrome secondary to thrombosis is increasing as venous access devices are used more commonly, and it is important that the catheter should be positioned well down in the vena cava to prevent thrombotic complications. Talc remains the best agent to achieve sclerosis of the pleural cavity, but doxycycline and minocycline are also quite effective replacements for tetracycline, which is no longer available. Radiation-induced pneumonitis and esophagitis continue to limit the total dose and the field that may be administered within the thoracic cavity. As combined modality treatment programs are developed and as doses of chemotherapeutic agents and radiation are both intensified, steps must be taken to ensure that the added toxicity of such treatment can be justified by a significantly superior outcome.
上腔静脉阻塞很少是真正的紧急情况，在没有充分的组织诊断之前不应进行治疗。对于因侵入性操作而手术风险较高的患者，在超声引导下对纵隔肿块进行经皮活检的诊断率很高。随着静脉通路装置的更广泛使用，继发于血栓形成的上腔静脉综合征正在增加，重要的是导管应放置在腔静脉的较低位置以预防血栓形成并发症。滑石粉仍然是实现胸腔硬化的最佳药物，但强力霉素和米诺环素也是四环素（已不再可用）的相当有效的替代品。放射性肺炎和食管炎继续限制胸腔内可给予的总剂量和照射野。随着联合治疗方案的发展以及化疗药物剂量和放疗剂量的增加，必须采取措施确保这种治疗增加的毒性能够通过显著更好的结果得到合理证明。
