中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2015年
8期
746-749
,共4页
李斌%宋铁牛%张建华%王志强%王成%杨建宝%魏小平
李斌%宋鐵牛%張建華%王誌彊%王成%楊建寶%魏小平
리빈%송철우%장건화%왕지강%왕성%양건보%위소평
纵隔镜%血管腔内成形术%杂交%上腔静脉梗阻%支架
縱隔鏡%血管腔內成形術%雜交%上腔靜脈梗阻%支架
종격경%혈관강내성형술%잡교%상강정맥경조%지가
Mediastinoscope%Endovascular angioplasty%Hybrid%Superior vena cava obstruction%Stent
目的 总结电视纵隔镜检查术后同期行上腔静脉支架置入诊断治疗上腔静脉综合征(SVCS)的临床经验,探讨其临床应用价值.方法 回顾性分析2007年11月至2013年10月间9例上腔静脉综合征患者的临床资料,术前均未获得明确病理诊断.采用弹簧气管插管静脉复合全身麻醉,先行电视纵隔镜检查术,同期再经股静脉置入上腔静脉支架治疗.结果 行标准颈部电视纵隔镜检查术6例、胸骨旁电视纵隔镜检查术2例、联合颈部与胸骨旁电视纵隔镜检查术1例.9例均获得明确病理学诊断,无手术死亡,并发渗血1例,填塞压迫后止血.上腔静脉支架置入术后即刻右肘正中静脉压平均(18.6±5.1) cmH2O,24h后平均(13.5±3.3)cmH2O,48 h后平均(11.3±2.5)cmH2O,72 h后平均(10.3±2.0)cmH2O,72 h内静脉压明显下降至正常水平(F=67.245,P＜0.01);临床症状明显缓解,随访中无上腔静脉梗阻复发.结论 电视纵隔镜检查同期行上腔静脉支架置入手术安全、有效,是其他技术无法获得明确病理诊断的上腔静脉综合征可靠的诊断治疗方法.
目的 總結電視縱隔鏡檢查術後同期行上腔靜脈支架置入診斷治療上腔靜脈綜閤徵(SVCS)的臨床經驗,探討其臨床應用價值.方法 迴顧性分析2007年11月至2013年10月間9例上腔靜脈綜閤徵患者的臨床資料,術前均未穫得明確病理診斷.採用彈簧氣管插管靜脈複閤全身痳醉,先行電視縱隔鏡檢查術,同期再經股靜脈置入上腔靜脈支架治療.結果 行標準頸部電視縱隔鏡檢查術6例、胸骨徬電視縱隔鏡檢查術2例、聯閤頸部與胸骨徬電視縱隔鏡檢查術1例.9例均穫得明確病理學診斷,無手術死亡,併髮滲血1例,填塞壓迫後止血.上腔靜脈支架置入術後即刻右肘正中靜脈壓平均(18.6±5.1) cmH2O,24h後平均(13.5±3.3)cmH2O,48 h後平均(11.3±2.5)cmH2O,72 h後平均(10.3±2.0)cmH2O,72 h內靜脈壓明顯下降至正常水平(F=67.245,P＜0.01);臨床癥狀明顯緩解,隨訪中無上腔靜脈梗阻複髮.結論 電視縱隔鏡檢查同期行上腔靜脈支架置入手術安全、有效,是其他技術無法穫得明確病理診斷的上腔靜脈綜閤徵可靠的診斷治療方法.
목적 총결전시종격경검사술후동기행상강정맥지가치입진단치료상강정맥종합정(SVCS)적림상경험,탐토기림상응용개치.방법 회고성분석2007년11월지2013년10월간9례상강정맥종합정환자적림상자료,술전균미획득명학병리진단.채용탄황기관삽관정맥복합전신마취,선행전시종격경검사술,동기재경고정맥치입상강정맥지가치료.결과 행표준경부전시종격경검사술6례、흉골방전시종격경검사술2례、연합경부여흉골방전시종격경검사술1례.9례균획득명학병이학진단,무수술사망,병발삼혈1례,전새압박후지혈.상강정맥지가치입술후즉각우주정중정맥압평균(18.6±5.1) cmH2O,24h후평균(13.5±3.3)cmH2O,48 h후평균(11.3±2.5)cmH2O,72 h후평균(10.3±2.0)cmH2O,72 h내정맥압명현하강지정상수평(F=67.245,P＜0.01);림상증상명현완해,수방중무상강정맥경조복발.결론 전시종격경검사동기행상강정맥지가치입수술안전、유효,시기타기술무법획득명학병리진단적상강정맥종합정가고적진단치료방법.
Objective To summarize the clinical experiences of video-mediastinoscopy followed by stenting procedure in treating the superior vena cava syndrome (SVCS),and to investigate their application significant.Methods Nine patients with SVCS without clear histologic diagnosis before procedure were reviewed retrospectively,who were admitted into hospital from November 2007 to October 2013.All of 9 patients were received video-mediastinoscopy and they did not performed pathological check.They were placed the endovascular stent.Results Video-mediastinoscopy followed by stenting procedure 6 cases,parasternal TN mediastinoscopy 2 cases,joint neck and parasternal TV mediastinoscopy 1 case.Nine cases have received a clear pathological diagnosis.There was no death case in-hospital.The operative complication was hemorrhage of 1 case.The cubital venous pressures were (18.6±5.1) cmH2O at stending,(13.5±3.3) cmH2O,(11.3±2.5) cmH2O,(10.3± 2.0) cmH2O at 24,48,72 h after stending,and down to the normal at 72 h (F =67.245,P ＜0.01).The clinical symptoms were obviously relieved.All of them were remained free from SVCS during the follow-up.Conclusion The hybrid procedure of video-mediastinoscopy followed by stenting placement is a highly effective and safe treatment.It can accurately provide informations on diagnosis and treatment.
