择区性颈清扫术后颈内静脉的功能评价  

Patency and flow of the internal jugular vein after selective neck dissection

作　　者：邢巍巍[1] 蔡晓妮[1] 谷京城[1] 

机构地区：[1]辽宁医学院附属第一医院耳鼻咽喉科,辽宁锦州121001

出　　处：《临床耳鼻咽喉头颈外科杂志》2012年第9期385-388,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:通过彩色多普勒超声检查,评价头颈部恶性肿瘤患者行择区性颈清扫术后颈内静脉(IJV)的功能。方法:行单侧或双侧择区性颈清扫术的下咽、喉鳞状细胞癌患者40例(共76侧IJV),按手术清扫范围大小将76侧IJV分为2组:A组行Ⅱ、Ⅲ区清扫(39侧);B组行Ⅱ～Ⅳ区和Ⅱ～Ⅴ区清扫(37侧)。所有患者在术前和术后1、3个月超声检查IJV有无血栓形成、呼气流量、呼气内径,呼气和捏鼻鼓气时的面积及流速,将结果进行统计分析。结果:①术前及术后76侧IJV均无血栓形成;②术后1、3个月IJV的通畅率分别为85.5%和96.1%,A、B组比较均差异无统计学意义(均P>0.05);③A、B组术后1个月除捏鼻鼓气时流速外,其余各项指标与术前比较均差异有统计学意义(均P<0.05);术后3个月除呼气时面积外,其余各项指标与术前比较均差异有统计学意义(均P<0.05);A、B组术后1、3个月比较,除呼气流速外,其余各指标比较均差异有统计学意义(均P<0.05);④不同手术清扫范围对IJV各指标的影响均差异无统计学意义(均P>0.05)。结论:①择区性颈清扫术后IJV均无血栓形成,说明术中细致操作、运用正确的手术技巧及采用恰当的术后处理可以避免IJV血栓形成;②IJV各项指标在择区性颈清扫术后早期有变化,但在术后3个月时多数指标有所恢复,呼气流量可以恢复至术前水平,说明术后较长时间IJV能恢复正常回流功能。Objective：Evaluating the function of the internal jugular vein aftre selective neck dissection on patients affected by squamous cell carcinoma of the head and neck by color Doppler ultrasonography.Method：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-Ⅴspring 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.Result：①None of the 76 internal jugular veins showed thrombosis before or after selective neck dissection.②Patency 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（P0.05）.③In group A,Valsalva flow speed showed no significant changes at the 1st postoperative months（P0.05）,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（P0.05）,compared with preoperative.In group B,Valsalva flow speed showed no significant changes at the 1st postoperative months（P0.05）,compared with preoperative;The remainings showed significant difference.Expiratory jugular flow had no significant difference at the 3rd postoperative mo

关 键 词：颈清扫术 颈内静脉 癌 鳞状细胞 

分 类 号：R762[医药卫生—耳鼻咽喉科]