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目的 探讨右心房及下腔静脉内联合置入内支架治疗累及右心房的恶性下腔静脉狭窄的安全性与疗效。方法 5例男性晚期肝癌患者 ,年龄 42～ 6 5岁 ,平均 5 6 3岁。肿瘤侵及下腔静脉和右心房下腔静脉入口引起下腔静脉阻塞 ,产生肝肿大、腹水、下肢水肿等症状和体征。选用“Z”形自膨胀不锈钢内支架 ,长度 7 5～ 10 0cm ,直径 2 5cm ,将其部分置入右心房 ,大部分置入下腔静脉 ,以开通阻塞的下腔静脉 ,心腔段内支架置入长度 1～ 3cm。结果 内支架均置入成功 ,阻塞的下腔静脉全部开通。患者下腔静脉阻塞症状和体征均明显减轻或消失。随访 6 7～ 188d ,下腔静脉阻塞症状未见复发 ,也无与内支架置入有关的心脏并发症。结论 对累及右心房的恶性下腔静脉狭窄采用右心房和下腔静脉联合内支架置入术是一种安全、有效的治疗方法。
Objective To investigate the safety and efficacy of the treatment of malignant inferior vena cava stenosis involving the right atrium using a stent in the right atrium and inferior vena cava. Methods Five male patients with advanced liver cancer were aged 42-65 years old with an average of 563 years old. Invading the inferior vena cava and invading the inferior vena cava of the inferior vena cava caused an obstruction of the inferior vena cava, resulting in hepatomegaly, ascites, edema of the lower extremities, and other symptoms and signs. Select “Z” shaped self-expanding stainless steel stent, length 75 ~ 10 0cm, diameter 25cm, part of it is placed into the right atrium, most of them into the inferior vena cava, in order to open the blocked inferior vena cava, within the heart cavity segment The stent is placed in a length of 1 to 3 cm. Results All the stents were implanted successfully and all the obstructed inferior vena cava were opened. The symptoms and signs of inferior vena cava obstruction were significantly reduced or disappeared. During follow-up period of 67 to 188 days, there was no recurrence of symptoms of inferior vena cava obstruction and there was no cardiac complication associated with stent placement. Conclusions The use of right atrium and inferior vena cava combined with stent placement for the treatment of malignant inferior vena cava stenosis involving the right atrium is a safe and effective treatment.