正中开胸上腔静脉人工血管置换的程序化处理在胸部肿瘤外科治疗中的应用

BACKGROUND The involvement of superior vena cava is a common condition in locally advanced thoracic tumors. Patients may benefit from the high risk operation. This study proposed a programmed procedure to optimize surgical techniques, which can facilitate the safety of operation via median thoracotomy. METHODS A total of 35 patients with thoracic disease involved superior vena cava underwent prosthetic vascular reconstruction via median thoracotomy. All patients were confirmed locally advanced without distant metastasis including 16 pulmonary neoplasm and 19 mediastinal disease. The operations proceed from left to right with one direction manner. The initial part of the left innominate vein was dissected, then cut off, so as to lift tumor, the pericardium was opened, and the left innominate vein and the right artrium were bridged with prosthetic vascular. The proximal end of the superior vena cava which not invaded was dissected and the tumor was pulled to the caudal side, the right mediastinal pleura was opened and the right inner mammary vascular was ligated and the right innominate vein was fully revealed. Stretch the tumor to left top, cut azygos vein on above the hilum, then block the right innominate vein and superior vena cava, removed involved part of blood vessels, the right innominate vein and superior vena cava was connected with prosthetic vascular. With these procedures the superior vena cava was reconstructed completely. RESULTS The operation was completed successfully in all cases. Postoperative complications included 6 cases with arrhythmia, 5 cases with hypoxemia, 1 case with myasthenia crisis, 1 case with cardiac hernia, and 2 cases with fungal infection. 2 patients died of myocardial infarction and lung infection respectively with a mortality rate of 5.12%. The remaining 33 cases were discharged successfully. The average postoperative hospital stay was 15 days. Of the 10 patients with superior vena cava syndrome preoperatively, 8 patients had symptoms relief except 2 cases with intraoperative intravascular thrombosis. CONCLUSIONS We recommended the programmed procedure of prosthetic reconstruction of the superior vena cava, standardize the details of treatment, and minimize the risk during operation. The safe surgical procedures of this group of cases confirm this practice.