- 期刊
Percutaneous Stenting for Malignant Superior Vena Cava Syndrome: A Case Report and Review of the Literature
使用經皮支架裝置治療惡性上腔靜脈症候群：病例報告及文獻回顧
摘要
上腔靜脈症候群是因為上腔靜脈症及其分枝發生明顯狹窄或阻塞所引起的臨床表現，常見的症狀包括喘、咳嗽、胸痛、臉部及上肢浮腫、發紺、頭痛等、惡性疾病（尤其是肺癌）約佔80-85%之病例。惡性上腔靜脈症候群之治療，傳統上是使用放射治療或是化學治療，然而這兩種方式產生的效果通常較慢而且不完全，而手術方式雖然可以有效地緩解症狀，但是須承擔手術的風險，且其長期存活率並不佳。近年來由於血管內支架裝置技術的改進，經皮放入金屬性的血管內支架改善了上腔靜脈症候群的治療，它可以迅速地緩解症狀，而且也逐漸成為治療惡性上腔靜脈症候群的首要選擇。本文中，我們報告一位74歲女性病人，因扁平細胞肺癌而引起上腔靜脈症候群，患者拒絕接受化學治療，且對放射治療反應不佳，經進行經皮支架裝置治療後有良好的反應；同時我們並回顧過去以經皮支架裝置治療惡性上腔靜脈症候群之文獻。
並列摘要
Superior vena cava (SVC) syndrome is the clinical expression for the significant narrowing or occlusion of the SVC and its branches. Malignancies (especially lung cancers) are the underlying cause in 80-85% of cases. Radiation therapy and chemotherapy are often used to treat malignant SVC syndrome. However, both result in slow and sometimes incomplete regression of the symptoms. With the refinement of endovascular stents in recent years, the percutaneous insertion of a metallic intravascular stent has improved the outcome and lessened the morbidity of SVC syndrome. We report a 74-year-old woman who had been diagnosed with squamous cell carcinoma of the lung, stage IIIB, 3 months previously, and who declined chemotherapy. She developed SVC syndrome about 2 weeks prior to admission. Her symptoms were not relieved by palliative radiotherapy. Balloon dilatation of the stricture was performed, and a 14 mm metallic stent was placed in the right subclavian vein and SVC. Symptoms improved thereafter, although she had fluctuating right arm swelling about one week later, but this was less severe and extensive than the initial event.