Internal jugular vein patency after lateral neck dissection: a prospective study
Internal jugular vein patency after lateral neck dissection: a prospective study
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颈侧清扫术后颈内静脉通畅：一项前瞻性研究
DOI：
10.1007/s00405-002-0479-5
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发表时间：
2002
影响因子：
2.6
通讯作者：
P. Nicolai
中科院分区：
文献类型：
--
作者：
J. Cappiello;C. Piazza;M. Berlucchi;G. Peretti;L. D. De Zinis;R. Maroldi;P. Nicolai
尽管颈内静脉(IJV)在解剖学上得到了保留，但选择性或改良根治性颈淋巴清扫术后，血管闭塞率高达30%。本前瞻性研究的目的是评价34例上呼吸道鳞状细胞癌患者行选择性侧颈清扫术(LND)后IJV的通畅性。单侧LND 18例，双侧LND 16例，共50个IJV。对4名有微囊外扩散的组织学证据的患者进行术后颈部放射治疗；通过Fisher检验评估这一变量对IJV通畅性的影响。术前通过超声(US)进行静脉通畅和血流的基线研究。分别于术后1周、1个月、3个月进行术后对照。无一例患者发生伤口感染或咽皮肤瘘，在术后过程中也未观察到IJV闭塞的体征或症状。在第一个US对照中，25个IJV(50%)没有任何通畅性改变，23个(46%)和2个(4%)分别有血流减少或消失。在第二个和第三个对照中，33个(66%)和45个(90%)的IJV表现为正常血流。在研究结束时，没有一名患者表现出闭塞的证据。术后放疗对IJV通畅率无统计学意义(P=0.09)。总之，LND后长期的IJV闭塞必须被认为是一种非常罕见的事件，发病率可以忽略不计。然而，IJV血流的改变经常发生在术后即刻。
In spite of anatomical preservation of the internal jugular vein (IJV), an occlusion rate of the vessel of up to 30% has been documented after selective or modified radical neck dissections. The aim of the present prospective study was to evaluate the patency of the IJV following selective lateral neck dissection (LND) in 34 patients affected by squamous cell carcinoma of the upper aerodigestive tract who underwent surgery concomitantly on the primary site and the neck. Eighteen patients received unilateral and 16 bilateral LND, for a total of 50 IJVs. Postoperative radiotherapy on the neck was delivered in four patients with histologic evidence of micro-extracapsular spread; the impact of this variable on IJV patency was assessed by the Fisher test. A preoperative baseline study of vein patency and flow by ultrasonography (US) was obtained. Postoperative controls were scheduled at 1 week, 1 month and 3 months following surgery. No patient developed either wound infection or a pharyngocutaneous fistula, and no signs or symptoms of IJV occlusion were observed during the postoperative course. At the first US control, 25 IJVs (50%) did not present any alteration in patency, and 23 (46%) and 2 (4%) had a reduced or absent flow, respectively. At the second and third controls, 33 (66%) and 45 (90%) of the IJVs presented with normal flow, respectively. At the end of the study, none of the patients showed evidence of occlusion. Postoperative radiotherapy did not have a statistically significant impact on IJV patency (P=0.09). In conclusion, long-term IJV occlusion after LND has to be considered an exceedingly rare event with negligible morbidity. However, alterations of IJV flow frequently occur in the immediate postoperative course.