论文部分内容阅读
目的 总结 6 4例胸部肿瘤浸润大血管手术时的处理经验 ,分析上腔静脉 (SVC)手术技术及指征以及肺动脉袖状切除的适应证。 方法 回顾性分析 1991年 1月到 1999年 6月 6 4例胸内大血管受到肿瘤浸润患者的手术经验。受侵血管包括肺动脉根部和 (或 )肺动脉干、上肺静脉和 (或 )下肺静脉根部、SVC和 (或 )无名静脉。 结果 2 4例接受了不同类型的SVC手术 ,包括左及右无名静脉分别与右心房人工血管搭桥术 1例、左无名静脉与右心房人工血管搭桥 4例、右无名静脉与右心房搭桥 3例、奇静脉切除并SVC部分切除 11例、单纯SVC部分切除 5例。SVC置换或搭桥除 1例应用涤纶血管者外 ,其余均是Gore Tex人工血管。 5例部分切除者使用了缝合器。 41例肺动脉部分或袖状切除 (肺动脉袖状并支气管袖状成形 4例 )、左心房部分切除 13例。应用肺血管阻断或临时架桥术 ,所有手术均成功进行 ,无手术死亡 ,无严重并发症。SVC切除后生存时间最长者已达l5年 ,为 1例恶性畸胎瘤患者。肺癌切除SVC、无名静脉搭桥患者术后生存最长者已达 5年。 结论 大血管包括SVC及肺血管阻断与成形技术以及SVC置换术 ,是根治性切除浸润大血管的胸部肿瘤的关键性技术 ,正确及时地应用可以提高根治性切除率和安全性 ,减少探查率。
Objective To summarize the experience of treatment of 64 cases of thoracic tumor invasive vascular surgery, and to analyze the surgical techniques and indications of superior vena cava (SVC) and indications of pulmonary sleeve sleeve resection. METHODS: Retrospective analysis was conducted from January 1991 to June 1999 on operative experience of 64 patients with large invasive thoracic vessels. Invasive vessels include the pulmonary artery roots and (or) pulmonary artery stems, the upper pulmonary veins and (or) the lower pulmonary vein roots, SVC, and (or) innominate veins. Results Twenty-four patients underwent different types of SVC, including left and right innominate veins and right atrium artificial vascular bypass grafting in 1 case, left innominate vein and right atrium artificial bypass in 4 cases, right innominate vein and right atrium bypass in 3 cases. , odd vein resection and partial resection of SVC in 11 cases, partial SVC resection in 5 cases. SVC replacement or bypass was performed except for one case where polyester vascular was applied, and the rest were Gore Tex artificial blood vessels. A stapler was used in 5 cases of partial resection. 41 cases of pulmonary artery or sleeve-like resection (pulmonary artery sleeve and bronchial sleeve formation in 4 cases), left atrial partial resection in 13 cases. With pulmonary vascular occlusion or temporary bridging, all operations were performed successfully, with no operative death and no serious complications. The longest survival time after SVC resection has been up to l5 years, which is a case of malignant teratoma patients. Lung cancer resection SVC and innominated venous bypass patients survived the longest after 5 years. Conclusion Large vessels including SVC, pulmonary artery occlusion and forming techniques and SVC replacement are the key techniques for the radical resection of thoracic tumors infiltrating large vessels. Proper and timely application can improve the radical resection rate and safety, and reduce the exploration rate. .