Bilateral radical neck dissection with unilateral internal jugular vein reconstruction
Bilateral radical neck dissection with unilateral internal jugular vein reconstruction
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DOI：
10.1097/00005537-199811000-00019
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发表时间：
1998-11-01
期刊：
影响因子：
2.6
通讯作者：
Lehmann, W
中科院分区：
文献类型：
--
作者：
Dulguerov, P;Soulier, C;Lehmann, W
目的：描述和评价双侧根治性颈淋巴清扫术（RND）后颈内静脉置换术的功能和肿瘤学结果。研究设计：回顾性历史队列研究。研究方法：自1972年以来，所有接受双侧RND并切除双侧颈内静脉的患者（n = 9）均重建一侧颈内静脉。在6例病例中，RND分期，在3例病例中，RND同时进行。在每种情况下，血管重建进行了自体静脉移植。所有患者均接受了放射治疗，其中5例患者在静脉移植前，4例患者在静脉移植后。根据术后头颈部和神经系统并发症评价功能结果。在一些患者中，进行多普勒扫描以评估静脉通畅性。肿瘤学结果报告为无复发生存期和死亡率间隔。结果：所有患者的术后过程顺利，无神经系统并发症。4例患者出现面部水肿，3例轻度，1例中度。2例患者存活，随访时间为8年和18年。7例患者死亡，2例无复发证据，4例平均生存10个月后颈部复发，1例生存7年后发生远处转移。在长期存活的患者中，多普勒扫描证实了静脉移植物的通畅性。结论：无手术并发症和无术后神经系统并发症使得双侧RND后单侧颈内静脉置换术具有吸引力，尽管肿瘤学结果仍然较差。
Objective: To describe and evaluate the functional and oncologic results of one internal jugular vein replacement after bilateral radical neck dissection (RND). Study Design: A retrospective historical cohort study. Methods: Since 1972 all patients (n = 9) undergoing bilateral RND with resection of both internal jugular veins had a reconstruction of one internal jugular vein. In six cases the RNDs were staged, and in three cases the RNDs were performed simultaneously. In every case a vascular reconstruction was performed with an autologous vein graft. All patients received radiation therapy, in five patients before and in four patients after the vein grafting. Functional results were evaluated in terms of postoperative head and neck and neurologic complications. In some patients a Doppler scan was performed to assess vein patency. Oncologic results are reported as relapse-free survival and mortality intervals. Results: In all patients the postoperative course was uneventful, without neurologic complications. Facial edema was noted in four patients, mild in three and moderate in one. Two patients are alive, with follow-ups of 8 and 18 years. Seven patients are dead, two without evidence of recurrence, four with cervical recurrence after a mean survival of 10 months, and one after distant metastasis after a survival of 7 years. In patients with long-term survival a Doppler scan confirmed the patency of the vein graft. Conclusion: The lack of operative complications and the absence of postoperative neurologic complications make a unilateral internal jugular vein replacement after bilateral RND attractive, although the oncologic results remain poor.