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恶性肿瘤相关性上腔静脉综合征

Authors
Reed E Drews, MD
Dmitry J Rabkin, MD, PhD
Section Editors
Eduardo Bruera, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editors
Diane MF Savarese, MD
Kathryn A Collins, MD, PhD, FACS
Translators
王健, 主治医师

引言

任何导致上腔静脉(superior vena cava, SVC)血流受阻的情况均可引起SVC综合征。阻塞可由累及右肺、淋巴结及其他纵隔结构的邻近的病理过程直接侵犯或外部压迫SVC所致，也可因SVC内血栓形成导致。在某些情况下，外部压迫与血栓形成共存[1]。

抗生素问世前，梅毒性胸主动脉瘤、纤维性纵隔炎及其他未治疗感染的并发症是导致SVC综合征的常见病因。抗生素问世后，恶性肿瘤成为引起SVC综合征的最常见病因，占到总病例数的90%。最近，血栓形成所致SVC综合征的发病率已升高，主要是因为血管内装置(如，中心静脉导管和起搏器导线)应用增多。目前，良性病因所致SVC综合征占总病例数的20%-40%。

本专题着重讨论SVC综合征的病因、临床表现、诊断及治疗，尤其是对恶性肿瘤患者的处理。非癌症患者在血液透析和其他留置血管内导管情况下中心静脉血栓的处理将在别处讨论。 (参见“Thrombosis associated with chronic hemodialysis vascular catheters”和“透析通路相关的中心静脉狭窄”和“导管相关性上肢静脉血栓形成”)

病理生理学

SVC阻塞可由累及右肺、淋巴结或其他纵隔结构的邻近的病理过程直接侵犯或外部压迫所致，也可因SVC内血栓形成导致。随着SVC内血流受阻，静脉侧支形成，为静脉血返回右心房建立了替代通路(图 1)。侧支静脉可能源于奇静脉、胸廓内静脉、胸外侧静脉、椎旁静脉和食管静脉系统(影像 1)。

侧支静脉在数周内扩张。因此，上身静脉压最初会显著升高，但随时间推移降低。然而，即使存在发展良好的侧支引流模式，中心静脉压力仍会升高，产生SVC综合征的特征性体征和症状。

                                     

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Literature review current through: 2017-07 . | This topic last updated: 2017-05-05.
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