[Application of vascular surgery in the treatment of thoracic neoplasm]

To investigate superior vena cava (SVC) and anonymous vein resection with prosthesis replacement for lung carcinoma and mediastinal tumor, and to assess the surgical procedure and prognosis.

Experimental research: Eighteen adult dogs were divided randomly into two groups. Group A (n = 9) underwent blocking of the SVC system, and Group B (n = 9) underwent SVC resection with prosthesis replacement. The SVC pressure and histological changes of brain tissue were measured and evaluated for group A. The histological changes of prosthesis were studied in group B. Clinical research: Fifty-six patients with thoracic neoplasm were studied, of which 42 were lung carcinoma and 14 were mediastinal tumor. Resection of primary lesions and metastatic lymph nodes with replacement of SVC system were performed for all patients. Long-term follow-up was performed.

Experimental research: In Group A, the pressure of SVC was higher when both SVC and the azygous vein were blocked as compared to SVC blocking only (P < 0.05); hyperemia and edema of brain tissue were not observed in two-hour obstruction. The inner face of vascular prosthesis was covered with fibrin two months after operation in group B. Vascular endothelial cells were found to grow in it, and there was no thrombosis without anticoagulation. Clinical research revealed that there was no death associated with the operation and there was no early or late obstruction of SVC. The survival rates of the patients with lung carcinoma in 1, 3 and 5 years were 84.2% 40.9% and 38.9% respectively. The patients with mediastinal tumor were all alive except 1 patient who died of metastasis.

Radical resection combined with prosthesis replacement of SVC system extends the indications of thoracic neoplasm resection and improve the long-term survival rate and living qualities of the patients. It may be recommended in the surgical treatment of thoracic tumor.