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目的 探讨血管内支架治疗上腔静脉阻塞综合征的技术和临床应用效果。方法 9例上腔静脉阻塞综合征患者 ,原发病灶均由病理组织学诊断为恶性肿瘤 (右上肺中央型肺癌 )。行右股静脉穿刺 ,在造影像上测量狭窄长度及正常上腔静脉直径 ,选择适当支架 ,原则上支架直径应超过正常上腔静脉直径 10 % ,上下端应超过狭窄段 1-2cm。成功后用球囊扩张支架。术后继续治疗原发疾病并抗凝治疗 ,透视或胸片观察支架位置 ,多普勒了解上腔静脉通畅情况。结果 支架置入后行DSA见造影剂回流通畅 ,上腔静脉管径接近正常 ,侧支循环明显减少。上腔静脉压由开通前平均 2 6 .4cmH2O降至15 .7cmH2O ,经统计学处理有显著性差异 (P <0 .0 1)。相关临床症状、体征消失或缓解。头颈部、上肢、胸壁肿胀 2天内消退 ,尿量增多 ,胸壁浅静脉怒张消失。结论 支架术治疗上腔静脉综合征微创、简单、有效 ,值得推广。
Objective To investigate the technique and clinical application of endovascular stent in the treatment of superior vena cava obstruction syndrome. Methods Nine patients with superior vena cava occlusive syndrome were diagnosed as malignant tumors (right upper lung central lung cancer) by pathology. Right femoral vein puncture in the imaging of the stenosis length and normal measurement of the diameter of the superior vena cava, select the appropriate stent, in principle, the stent diameter should exceed 10% of the normal diameter of the superior vena cava, the upper and lower ends should exceed the narrow segment 1-2cm. After successful balloon dilation stent. Postoperative treatment of primary disease and anticoagulant therapy, fluoroscopy or chest X-ray stent position, Doppler understanding of superior vena cava patency. Results The stent was placed in DSA, see the contrast agent reflux patency, superior vena cava diameter close to normal, collateral circulation was significantly reduced. The superior vena cava pressure dropped from an average of 24.4cmH2O before opening to 15.7cmH2O, which was statistically significant (P <0.01). Relevant clinical symptoms, signs disappeared or alleviated. Head and neck, upper extremities, chest wall swelling subsided within 2 days, increased urine output, superficial chest wall veins disappeared. Conclusion Stent surgery for the superior vena cava syndrome minimally invasive, simple and effective, it is worth promoting.