Xing Weiwei, Cai Xiaoni, Gu Jingcheng
Department of Otorhinolaryngology, First Affiliated Hospital, Liaoning Medical College, Jinzhou, 121001, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 May;26(9):385-8.
Evaluating the function of the internal jugular vein after selective neck dissection on patients affected by squamous cell carcinoma of the head and neck by color Doppler ultrasonography.
Forty patients (76 internal jugular veins) who had undergone bilateral selective neck dissection(36 patients) or unilateral selective neck dissection (4 patients) were collected and divided into 2 groups depending on operation area. Group A consisted of 39 internal jugular veins (IJVs) which dissected level II, III and group B included 37 IJVs which disseted level II - IVor II - V spring the IJV. All patients underwent Doppler ultrasonography before and after selective neck dissection at the 1st and 3rd postoperative months. The following measurements were assessed in each test: presence of thrombosis, expiratory jugular flow, expiratory caliber, area both during expiratory and Valsalva maneuver, expiratory flow speed, Valsalva flow speed. All data were statistically analyzed in two groups by comparisons of preoperative conditions and postoperative conditions.
(1) None of the 76 internal jugular veins showed thrombosis before or after selective neck dissection. (2) Patency rate at the 1st and 3rd postoperative months were respectively 85.5% and 96.1%. Patency rate of the internal jugular vein in two groups showed no significant changes at the 1st and 3rd postoperative months (P > 0.05). (3) In group A, Valsalva flow speed showed no significant changes at the 1st postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. Expiratory calibe, area during Valsalva maneuve, expiratory flow speed and Valsalva flow speed had significant difference at the 3rd postoperative months (P < 0.05), compared with preoperative. In group B, Valsalva flow speed showed no significant changes at the 1st postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. Expiratory jugular flow had no significant difference at the 3rd postoperative months (P > 0.05), compared with preoperative; The remainings showed significant difference. All parameters at the 3rd postoperative months had significant difference compared with 1st postoperative months between these two groups, excepting expiratory flow speed. (4) Differences of the operation area had no significant impact on indications of the internal jugular vein (P > 0.05).
(1) None of the internal jugular veins showed thrombosis after selective neck dissection. The results indicate that thrombosis of the internal jugular veins can be avoided though careful operation, proper operative skill, appropriate management postoperation. (2) Although most of the parameters changed at early stage after selective neck dissection, many of them improved at the 3rd postoperative months, and expiratory jugular flow recovered to the normal range. The results indicate that the internal jugular veins can basically maintain its normal function at long time postoperation.
通过彩色多普勒超声评估头颈部鳞状细胞癌患者选择性颈清扫术后颈内静脉的功能。
收集40例接受双侧选择性颈清扫术（36例）或单侧选择性颈清扫术（4例）的患者（76条颈内静脉），根据手术区域分为2组。A组包括39条在Ⅱ、Ⅲ区进行清扫的颈内静脉，B组包括37条在Ⅱ - Ⅳ区或Ⅱ - Ⅴ区清扫颈内静脉的颈内静脉。所有患者在选择性颈清扫术前及术后第1、3个月进行多普勒超声检查。每次检查评估以下指标：血栓形成情况、呼气时颈静脉血流、呼气时管径、呼气及瓦尔萨尔瓦动作时的面积、呼气流速、瓦尔萨尔瓦动作流速。通过术前与术后情况的比较对两组所有数据进行统计学分析。
（1）76条颈内静脉在选择性颈清扫术前及术后均未出现血栓形成。（2）术后第1、3个月的通畅率分别为85.5%和96.1%。两组颈内静脉在术后第1、3个月的通畅率无显著变化（P＞0.05）。（3）A组术后第1个月瓦尔萨尔瓦动作流速与术前相比无显著变化（P＞0.05），其余指标有显著差异。术后第3个月呼气时管径、瓦尔萨尔瓦动作时的面积、呼气流速及瓦尔萨尔瓦动作流速与术前相比有显著差异（P＜0.05）。B组术后第1个月瓦尔萨尔瓦动作流速与术前相比无显著变化（P＞0.05），其余指标有显著差异。术后第3个月呼气时颈静脉血流与术前相比无显著差异（P＞0.05），其余指标有显著差异。除呼气流速外，两组术后第3个月的所有参数与术后第1个月相比均有显著差异。（4）手术区域的差异对颈内静脉各项指标无显著影响（P＞0.05）。
（1）选择性颈清扫术后颈内静脉均未出现血栓形成。结果表明，通过仔细操作、适当的手术技巧及术后合理管理可避免颈内静脉血栓形成。（2）虽然选择性颈清扫术后早期多数参数发生变化，但术后第3个月许多参数有所改善，呼气时颈静脉血流恢复至正常范围。结果表明，颈内静脉在术后较长时间内基本可维持其正常功能。
