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目的 探讨上腔静脉及无名静脉切除 ,人工血管置换术在胸部肿瘤外科治疗中的应用及其临床效果。方法 实验研究 :健康成年犬 18只 ,分为单纯阻断组 :阻断上腔静脉或上腔静脉奇静脉联合阻断 (9只 ) ;人工血管置换组 :切除上腔静脉 ,行人工血管置换 (9只 )。对上腔静脉阻断前后上腔静脉压力的变化、人工血管置换后的病理改变、抗凝治疗及长时间阻断上腔静脉后脑组织的病理改变进行分析。临床研究 :胸部肿瘤患者 56例 ,其中肺癌 42例 ,纵隔肿瘤 14例。行肿瘤根治切除术及受侵上腔静脉和 (或 )无名静脉切除人工血管置换 ,并对患者进行长期随访。结果 实验研究 :实验犬上腔静脉加奇静脉阻断后 ,上腔静脉系统压力为 (49 2 8± 14 72 )cmH2 O(1cmH2 O =0 0 98kPa) ,高于单纯上腔静脉阻断的 (3 7 83± 1 3 5)cmH2 O (P <0 0 5) ;腔静脉阻断 2h未见脑实质充血及水肿 ;人工血管置换组犬术后 1个月血管腔内壁已有纤维素沉积 ,2个月始有部分血管内皮细胞移行覆盖 ;未应用抗凝治疗情况下血管无附壁血栓形成。临床研究 :全组患者无围手术期死亡及术后近、远期上腔静脉系统梗阻症状。肺癌组患者 1、3、5年生存率分别为 84%、41%、3 9% ;纵隔肿瘤患者术后 1例死亡。结论 血管外科技术的应用 ,扩大了胸部肿瘤外科手?
Objective To investigate the clinical application of superior vena cava and unnamed venous resection and prosthetic vascular replacement in the surgical treatment of thoracic tumors. Methods Experimental study: 18 healthy adult dogs were divided into simple block group: occlusion of the superior vena cava or superior vena cava vein occlusion (9); artificial vascular replacement group: removal of the superior vena cava, artificial vascular replacement (9). The changes of the pressure of the superior vena cava before and after the superior vena cava occlusion, the pathological changes after the artificial vascular replacement, the anticoagulant therapy and the pathological changes of the cerebral tissue after blocking the superior vena cava for a long time were analyzed. Clinical studies: 56 cases of chest cancer patients, including 42 cases of lung cancer, mediastinal tumor in 14 cases. Radical tumor resection and invasion of the superior vena cava and / or nameless vein resection of artificial vascular replacement, and long-term follow-up of patients. Results Experimental study: After the canine superior vena cava was occluded, the pressure of the superior vena cava was (49 2 8 ± 14 72) cmH 2 O (1 cmH 2 O = 0 0 98 kPa), which was higher than that of simple superior vena cava (3 7 83 ± 1 3 5) cmH 2 O (P 0 05). No cerebral parenchymal hyperemia and edema were observed 2 h after vena cava occlusion. Cellulose deposition was found on the inner wall of vascular lumen 1 month after artificial vascular replacement , 2 months ago, part of the vascular endothelial cell migration covered; no application of anticoagulant therapy without vessel thrombosis. Clinical study: All patients without perioperative death and postoperative proximal and distal superior vena cava obstruction symptoms. The 1-, 3- and 5-year survival rates of lung cancer patients were 84%, 41% and 39%, respectively. One patient died of mediastinal tumor after operation. Conclusion The application of vascular surgery to expand the chest tumor surgery?