Magnan P E, Thomas P, Giudicelli R, Fuentes P, Branchereau A
Service de Chirurgie Vasculaire, Hôpital Sainte Marguerite, Marseille, France.
Cardiovasc Surg. 1994 Oct;2(5):598-604.
Ten patients (eight men, two women) who underwent surgical reconstruction of the superior vena cava using an expanded polytretrafluoroethylene (ePTFE) prosthesis between 1981 and 1991 were reviewed to assess the therapeutic value of such surgery. The mean (s.d.) age was 55(12) years. Obstruction of the superior vena cava was caused by pulmonary or mediastinal cancer in nine patients and chronic mediastinitis in one. Eight patients had superior vena cava syndrome and two had symptoms of lung disease. The diagnosis of superior vena cava obstruction was made before surgery by computed tomography or superior venacavography in eight patients and during the surgical procedure in two. Tumour resection was performed in five patients. Venous reconstruction was achieved by interposition of an ePTFE graft between the proximal and distal end of the vena cava in three patients and between one (four cases) or two (three cases) tributaries of the superior vena cava and the right atrium in seven. No patient died during the perioperative period. Symptoms of superior vena cava obstruction disappeared promptly after operation in all patients. Postoperative patency was assessed by cavography or computed tomography; all the grafts were patent. During follow-up no patients presented with recurrent superior vena cava syndrome. Eight patients died. The cumulative survival rates were 70, 25 and 12.5% at 1, 2 and 5 years, respectively. Surgical reconstruction of the superior vena cava with an ePTFE prosthesis provided immediate and long-term relief of symptoms of superior vena cava obstruction with a low surgical morbidity, even in patients with unresectable malignancy.
回顾了1981年至1991年间接受使用膨体聚四氟乙烯（ePTFE）人工血管进行上腔静脉手术重建的10例患者（8例男性，2例女性），以评估该手术的治疗价值。平均（标准差）年龄为55（12）岁。9例患者的上腔静脉梗阻由肺部或纵隔肿瘤引起，1例由慢性纵隔炎引起。8例患者患有上腔静脉综合征，2例有肺部疾病症状。8例患者在手术前通过计算机断层扫描或上腔静脉造影确诊上腔静脉梗阻，2例在手术过程中确诊。5例患者进行了肿瘤切除。3例患者通过在腔静脉近端和远端之间置入ePTFE移植物实现静脉重建，7例患者通过在上腔静脉的一条（4例）或两条（3例）支流与右心房之间置入ePTFE移植物实现静脉重建。围手术期无患者死亡。所有患者术后上腔静脉梗阻症状立即消失。通过腔静脉造影或计算机断层扫描评估术后通畅情况；所有移植物均通畅。随访期间无患者出现复发性上腔静脉综合征。8例患者死亡。1年、2年和5年的累积生存率分别为70%、25%和12.5%。使用ePTFE人工血管对上腔静脉进行手术重建可立即并长期缓解上腔静脉梗阻症状，手术并发症发生率低，即使是患有无法切除恶性肿瘤的患者。
