The Guiding Significance of the Choice of Surgical Strategy of Intraoperative Oxygen Metabolism during Superior Vena Cava
Reconstruction for Thoracic Neoplasm
Abstract: Objective: To discuss the effects of the change of oxygen metabolism of the choice of surgical strategy during the superior vena cava reconstruction of thoracic neoplasm. Method: 31 patients underwent superior vena cava replacement from 2006 to 2013. The superior vena cava was totally obstructed in 12 patients and was partially involved in 19 patients. During the SVC replacement, the SVC were directly clamped in the SVCOS patients, and bypassed through the temporary SVC to right atrial bypass graft. The hemodynamic indexes, jagular oxygen index, and blood lactate were monitored during the operation. Results: SVC pressure, was significantly higher in the SVCO pa-tients before the operation than the non-SVCO patients (24.0 ± 8.9 mmHg & 11.0 ± 2.5 mmHg), and decreased significantly after SVC reconstruction (24.0 ± 8.9 mmHg & 14.6.0 ± 6.3 mmHg). The ce-rebral oxygen extraction rate, venous-arterial oxygen content difference and the jagular vein blood lactate level were significantly higher in the SVCOS patients comparing with no SVCO patients (36 ± 12 & 29 ± 1O; 0.51 ± 1.23 & 0 ± 0.21; 5.75 ± 2.36 & 3.54 ± 0.88), and decreased significantly after SVC replacement (36 ± 12 & 26 ± 12; 0.51 ± 1.23 & 0.28 ± 1.21; 5.75 ± 2.36 & 3.86 ± 1.75). The he-modynamic indexes and oxygen metabolism indexes were stable during the direct clamp of SVCO patients and bypass procedure of non-SVCO patients. Conclusion: The direct clamp of SVC for SVCO patients was safe and the efficacious bypass between SVC and right atrium was essential for non- SVCO patients during the SVC replacement of thoracic neoplasm.
文章引用: 何庚戌 , 要 彤 , 李海英 , 濮仁富 , 蔡宝松 , 张 雁 , 孙永杰 (2014) 胸部肿瘤上腔静脉重建术中脑氧代谢的变化对手术策略选择的指导意义。 外科， 3， 24-29. doi: 10.12677/HJS.2014.33006
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