胸腔内悪性腫瘍例における上大静脈再建術の経験

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  • Reconstruction of the Superior Vena Cava in Patients with intra-thoracic malignant tumor

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Reconstruction of the superior vena cava (SVC) was attempted in three patients with incomplete obstruction by malignant tumor, using a temporary internal shunt which was made with a caval catheter introduced from the right auricular appendage into the upper part of the SVC. The technique and results are reported herein.<BR>Two women, 56 and 54 years old respectively, were operated upon because of carcinoma in the upper lobe of the right lung. In these two patients using a temporary internal shunt, the involved area of the SVC, 1×2cm in size in both patients, was resected together with the right lung. The resected area of the SVC was reconstructed with an azygos vein patch in the first patient and with a pericardial patch in the second patient. The patency of the reconstructed SVC of the first patient was proved by angiography six months after surgery. No clinical symptoms of SVC obstruction were observed in either patient, up until the time of death from recurrent carcinoma twelve months after surgery in the first patient, and from the pneumonia 14 days after surgery in the second patient.<BR>The third patient, a 71-year-old man, was operated upon because of a progressive SVC syndrome caused by a thymoma. The pressure of the right innominate vein was 40cmH20. The tumor occluded completely the left innomintae vein and also envolved the right innominate vein and SVC, producing marked stenosis. Using a temporary internal shunt, the involved area of the veins was resected together with the tumor, leaving only one quater of the original circumference of a 7 cm portion of the SVC and the right innominate vein. During the procedure, the left innominate vein and azygos vein were ligated and the involved portion was divided. The venous system was reconstructed by joining three long strips of saphenous and external juglar vein grafts. The venous pressure after reconstruction was 5cmH2O and superior vena-cavogram done 12 months after surgery showed satisfactory patency. The patient has been healthy and asymptomatic for 27 months after surgery.

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  • 肺癌

    肺癌 18 (4), 401-408, 1978

    特定非営利活動法人 日本肺癌学会

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