Kamizono K, Ejima M, Taura M, Masuda M
Department of Otorhinolaryngology and Head and Neck Surgery, Kyushu Koseinenkin Hospital, Kitakyushu, Fukuoka, Japan.
J Laryngol Otol. 2011 Jun;125(6):643-8. doi: 10.1017/S0022215110003038. Epub 2011 Apr 1.
During neck dissection, the current practice is to preserve the internal jugular vein in the majority of cases. However, sacrifice of bilateral internal jugular veins is required in rare cases. Simultaneous excision of both internal jugular veins is known to frequently cause fatal complications. Even if staged, bilateral internal jugular vein sacrifice still occasionally leads to fatal complications (in 2 per cent). We report two different methods of unilateral internal jugular vein reconstruction, in two cases requiring excision of bilateral internal jugular veins, and we review the significance of this reconstruction procedure.
The first patient underwent conventional type A reconstruction (using Katsuno's classification): end-to-end anastomosis of the internal jugular vein to the external jugular vein. For the second patient, we anastomosed the internal jugular vein to the anterior jugular vein, preserving the flow of the external jugular vein. This method, termed type K, had two main expected benefits: facial drainage via the preserved external jugular vein; and provision of a built-in safeguard in the case of occlusion (via the preserved venous networks between the internal jugular vein and the external jugular vein, e.g. the facial vein).
In both cases, the reconstructed internal jugular vein was patent and the post-operative course was uneventful, with no severe complications.
The current and previous findings strongly indicate that the reconstruction of at least one internal jugular vein is highly recommended for patients requiring bilateral internal jugular vein sacrifice. Our type K method may represent a useful technique for this procedure.
在颈部清扫术中，目前的做法是在大多数情况下保留颈内静脉。然而，在极少数情况下需要双侧颈内静脉结扎。已知同时切除双侧颈内静脉经常会导致致命并发症。即使分期进行，双侧颈内静脉结扎仍偶尔会导致致命并发症（2%）。我们报告了两例需要切除双侧颈内静脉的患者采用的两种不同的单侧颈内静脉重建方法，并回顾了这种重建手术的意义。
第一例患者接受了传统的A型重建（采用胜野分类法）：颈内静脉与颈外静脉端端吻合。对于第二例患者，我们将颈内静脉与颈前静脉吻合，保留颈外静脉的血流。这种方法称为K型，有两个主要预期益处：通过保留的颈外静脉进行面部引流；在发生阻塞时提供内置保障（通过保留的颈内静脉和颈外静脉之间的静脉网络，如面静脉）。
两例患者重建的颈内静脉均通畅，术后过程顺利，无严重并发症。
目前及既往的研究结果强烈表明，对于需要双侧颈内静脉结扎的患者，强烈建议至少重建一条颈内静脉。我们的K型方法可能是该手术的一种有用技术。
