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目的通过分析肺癌侵犯上腔静脉的临床特点,探讨其外科手术治疗策略,以提高临床疗效。方法回顾性分析该院50例肺癌侵犯上腔静脉患者的临床资料,总结手术方式与病理类型、发病情况及术前辅助化疗情况的相关性,分析上腔静脉阻断时间、上腔静脉压力测定情况,并观察术后临床疗效及并发症情况,随访观察患者生存情况。结果手术方式采用以人工血管置换术最多,与其相关的病理类型SCLC多于NSCLS,相比差异有统计学意义(P<0.05);发病情况初治者少于复发者,相比差异有统计学意义(P<0.05);术前有辅助化疗者明显少于无辅助化疗者,二者相比差异有统计学意义(P<0.01);自体修补术上腔静脉阻断时间为3~15min,人工血管置换术阻断时间8~35min,相比差异有统计学意义(P<0.05);术前人工置换术压力虽高于自体修补术,但差异无统计学意义(P>0.05);而术中差异有统计学意义(P<0.05);术后患者上腔静脉压迫症状消失或基本缓解,临床疗效显著;术后发生心律失常、肺炎、肺不张及吻合口出血并发症,但通过治疗均治愈;患者1年生存率为58%,3年生存率为28%;且手术差异无统计学意义(P>0.05),术前有无辅助化疗差异有统计学意义(P<0.05)。结论外科手术治疗肺癌侵犯上腔静脉者,临床效果显著,可提高患者生活质量,延长生存期,且术前化疗更有助于疗效提高,临床值得推广。
Objective To analyze the clinical features of lung cancer invading the superior vena cava and discuss its surgical treatment strategies to improve the clinical efficacy. Methods A retrospective analysis of 50 cases of lung cancer invaded the superior vena cava in patients with clinical data to summarize the surgical approach and pathological types, incidence and preoperative adjuvant chemotherapy, the correlation between the analysis of superior vena cava occlusion time, superior vena cava pressure measurement The clinical efficacy and complications were observed. The survival of patients was followed up. Results The operation method was the most in all cases, and the pathological type SCLC was more than NSCLS. The difference was statistically significant (P <0.05) (P <0.05). There was a significant difference between preoperative adjuvant chemotherapy and non-adjuvant chemotherapy (P <0.01), while the superior vena cava occlusion time was between 3 and 15 minutes, The time of artificial vascular replacement was 8 ~ 35 minutes, the difference was statistically significant (P <0.05). The preoperative artificial replacement pressure was higher than autologous repair, but the difference was not statistically significant (P> 0.05) There was significant difference between the two groups (P <0.05). The superior vena cava compression symptom disappeared or basically relieved after operation, and the clinical curative effect was significant. The postoperative arrhythmia, pneumonia, atelectasis and complications of anastomotic bleeding occurred. The survival rate was 58% and the 3-year survival rate was 28%. There was no significant difference between the two groups (P> 0.05), but there was no significant difference between the two groups (P <0.05) . Conclusion Surgical operation of lung cancer invading the superior vena cava, the clinical effect is significant, can improve the quality of life of patients and prolong survival, and preoperative chemotherapy is more helpful to improve the efficacy of clinical worthy of promotion.