superior vena cava tumor resection

Superior vena cava syndrome is due to various causes of complete obstruction or partial obstruction of the vena cava blood flow, resulting in head, neck and upper extremity venous return disorder, swelling of the face, neck and upper limbs, cyanosis, elevated venous pressure , a group of clinical syndromes with respiratory and even neurological symptoms. The superior vena cava syndrome was first described as a complication of syphilitic aortic aneurysm in 1757 by William Hunter. According to the pathogen of superior vena cava syndrome, it is divided into benign and malignant diseases, and more than 90% are caused by malignant tumors. There are many causes of superior vena cava obstruction, and treatment decisions include: 1 Radiation therapy: is the most important basic treatment, because a large part of the superior vena cava syndrome is caused by malignant tumors that cannot be removed by surgery. 2 Medical comprehensive treatment includes Chinese and Western medicine and chemotherapy; used to reduce tumor volume or as an auxiliary means of radiotherapy. Raise the head to rest in bed, anticoagulation and ablation to reduce thrombosis, corticosteroids to reduce throat and cerebral edema, diuretics to reduce systemic edema and other symptoms. 3 surgery: through the vena cava transplantation or bypass grafting, effectively relieve the superior vena cava obstruction. 4 superior vena cava balloon dilatation: the addition of different types of endoluminal stents can quickly relieve the superior vena cava obstruction, the recent effect is better, the long-term effect is still under evaluation. The surgical method should be selected according to the cause, extent and extent of the disease: 1 According to the surgical approach, it can be divided into transthoracic surgery and non-thoracic surgery. Transthoracic surgery is traumatic and destroys more collateral circulation. It is suitable for young physique, difficult to operate, high technical requirements, can tolerate thoracotomy, and the surgical effect is relatively better; non-thoracic surgery is small, on the chest Less collateral damage, suitable for patients with severe infection in the thoracic cavity, or failure of thoracotomy, or patients who are unable to undergo thoracotomy. 2 According to different surgical methods, there are superior vena cava tumor resection, superior vena cava thrombectomy, tumor resection + superior vena cava reconstruction, and vascular bypass grafting. Treatment of diseases: mediastinal tumor Indication External vena cava tumor resection is suitable for superior vena cava syndrome caused by tumor compression, such as anterior mediastinal tumor, no thrombosis in the superior vena cava, and the tumor can be resected. Preoperative preparation Preoperative preparation should focus on understanding the patient's physical condition and whether there are contraindications for surgery, and complete the following: 1 laboratory tests: including blood routine, clotting time, blood type, prothrombin time, erythrocyte sedimentation rate, blood gas, blood biochemistry, liver Renal function, hepatitis virus antigen, antibody, blood sugar and blood rheology examination, etc., and urine and routine examination. 2 auxiliary examination: In addition to conventional electrocardiogram, echocardiography and chest X-ray examination, special examinations should be made for the cause: chest CT, superior vena cava or spiral CT or electron beam ultra-high-speed CT (EBCT). 3 Do a good job of explaining the patient, family or unit leader, including the nature of the disease, the intention of the operation and the possible complications and risks, so that they understand and cooperate. 4 patients with malignant tumors have poor nutrition, anemia, water and electrolyte disorders, should be corrected. 5 treatment of complications: patients with acute myocardial infarction, arrhythmia and heart failure first medical treatment; patients with hypertension should use antihypertensive drugs to make blood pressure as close to normal as possible; diabetics should be controlled by diet and drugs, such as pulmonary infection Should be active anti-infective treatment. Surgical procedure The patient was placed in a supine position, general anesthesia, endotracheal intubation, and a midline thoracic incision to carefully identify the relationship between the tumor and the superior vena cava and its surroundings under direct vision. Carefully separate the two with scissors and remove the tumor. After resection of the tumor, carefully check whether the superior vena cava is unobstructed, and completely stop the bleeding and then close the chest layer by layer.