Superior Vena Cava Syndrome in Lung Cancer: An Analysis of 54 Cases

傳統上，上腔靜脈症候群常被當成癌症的急症，一旦臨床上懷疑病人罹患此症候群，組織病理學上的確定診斷即很少去執行，主因恐怕侵襲性檢查產生的危險併發症或感受到此病對生命的即刻威脅。在過去，局部放射線治療已被認為是最好的立即性治療方式。但是我們統計分析過去 6 年內 54 個肺癌病人併上腔靜脈症候群的病人，結果顯示：雖然在症狀學上和胸部 X 一光的表現與其他文獻上的報告並無特別相異之處，都是呼吸困難，臉腫，與上縱膈腔變寬，但是在診斷的步驟上，我們以細針抽吸頸部淋巴結與經由超音波導引胸腔穿刺腫瘤方式，至少可以診斷解決一半以上的病例（ 28 病例， 51 % ）。更重要的是以上兩種檢查都相當安全，方便，沒有嚴重的併發症產生。在這些病人當中，比例最高的為小細胞肺癌，佔了 43 % ( 23 病例），經由化學治療後，大部分病人的症狀都能獲得改善，其存活時間可達到 7 . 4 個月；而非小細胞肺癌以傳統的局部放射線治療，只有 3 . 7 個月的存活時問。我們認為大多數的肺癌併上腔靜脈症候群病人可以迅速，安全的經由細針直接抽吸頸部淋巴結或超音波導引抽吸腫瘤而獲得診斷，而小細胞肺癌經由化學治療，大部份的症狀都能獲得改善並延長生命。

關鍵字

無資料

並列摘要

Traditionally, superior vena cava syndrome (SVCS) has been recognized as an oncologic emergency, and with clinical suspicion of the syndrome, tissue diagnosis was often delayed due to possible complications in diagnostic procedures and immediately threatening of life. Previously, local radiotherapy was regarded as the best immediate strategy for management of the condition. We have analyzed 54 lung cancer patients with SVCS in the past 6 years. Our results show that dyspnea (34 cases, 63%) and facial swelling (29 cases, 54%) are the two most common symptoms. The most frequent physical finding was venous distension of the neck (35 cases, 65%). The chest X-ray findings also showed a large ratio of superior mediastinal widening (26 cases, 48%). Fine needle aspiration of palpable lymph node (20 cases, 37%) and trans-thoracic needle aspiration guided by ultrasound (US) (8 cases, 14%) made diagnosis of at least half of the cases possible (28 cases, 51%). Both of these procedures are safer and easier than other invasive methods of examination. Of the 54 patients, small cell carcinoma constituted the majority of the cases (23 cases, 43%) and, with combination chemotherapy, there was a good response rate and a longer survival time (7.4 months) as compared to that of non-small cell carcinoma (3.7 months) treated by radiotherapy. We conclude that lung cancer with SVCS could be quickly and safely diagnosed by needle aspiration of the palpable lymph node or trans-thoracic needle aspiration quided by US, and that with combination chemotherapy the SVCS in small cell carcinoma can be effectively relieved.

並列關鍵字

superior vena cava syndrome(SVCS) ； lung cancer ； ultrasound

國際替代計量

Superior Vena Cava Syndrome in Lung Cancer: An Analysis of 54 Cases

全文下載

主題瀏覽