superior vena cava resection and artificial vascular replacement

The superior vena cava is fixed in the superior mediastinum, in front of the trachea and the right main bronchus, surrounded by many lymph nodes. Compression, envelopment, or disease of the external vena cava can cause obstruction of the venous return of the head and neck and upper body and a series of clinical signs and symptoms. Hunter first described this condition in 1957 and called it the superior vena cava syndrome. Treatment of diseases: mediastinal tumor Indication Superior vena cava excision for vascular replacement is applicable to: 1. The anterior mediastinal malignant tumor and the right non-small cell lung cancer invade the superior vena cava, and the tumor and superior vena cava can be completely removed. 2. Primary superior vena cava tumor. Contraindications 1. The primary malignant tumor can not be removed. 2. Rich collateral circulation has been established. 3. The proximal superior vena cava wall is not normal. Preoperative preparation 1. Conduct a comprehensive examination and assessment of the underlying disease. 2. All patients should have preoperative venography to understand the location, extent, and presence of thrombus in the proximal vein, and to determine the location of the proximal anastomosis. 3. Ultrasound to determine if the thrombus extends to the right atrium. 4. Head CT examination to assess the tolerance of brain tissue to intraoperative superior vena cava blockade. Surgical procedure 1. Right lung cancer is performed in the right posterior incision, and the anterior mediastinal tumor is incision in the chest. 2. Explore the primary tumor, superior vena cava, left and right innominate veins and right atrium to determine whether the superior vena cava can be removed and reconstructed. 3. Complete the main steps of primary tumor resection. Lung cancer is treated with pulmonary artery, pulmonary vein and bronchus first; mediastinal tumor is first dissected and separated from tumor outside the superior vena cava. 4. Strive to complete the primary tumor and superior vena cava, complete resection. In case of difficulty, the primary tumor is removed first, and the tumor remaining on the superior vena cava wall is subsequently removed together with the superior vena cava. 5. Before resection of the superior vena cava, dissect and free the proximal end of the superior vena cava (upper cavity - right atrial junction) and the distal end (the junction of the left and right innominate veins), and then set a separate Potts pliers. 6. After superior vena cava resection, an 18 or 20 polytetrafluoroethylene (PTFE) artificial blood vessel was used to anastomize the superior vena cava. Firstly, the distal end of the anastomosis was used. A 5-0 Prolene line was used to sew two traction lines between the distal end of the superior vena cava and the artificial blood vessel. After ligation, the anterior and posterior walls were sutured by a continuous valgus suture method. Outside the blood vessels. In the same way, it fits close to the heart. Before the proximal suture is not knotted, heparin saline is injected into the displaced blood vessel, then the distal Potts forceps are released, the air in the blood vessel is removed, and the proximal blocking forceps are removed.