血管纵向缩缝联合显微血管吻合术重建颈内静脉  

Jugular vein reconstruction by longitudinal constriction suture venoplasty and microvascular anastomosis

作　　者：任振虎[1] 范腾飞[1] 吴汉江[1] 王铠[1] 谭宏宇[1] 龚朝建[1] 刘金兵[1] 

机构地区：[1]中南大学湘雅二医院口腔颌面外科,长沙410011

出　　处：《华西口腔医学杂志》2014年第5期476-479,共4页West China Journal of Stomatology

摘　　要：目的探讨晚期口腔癌患者颈部转移淋巴结累及双侧颈内静脉时血管的处理新方式。方法采用显微血管吻合术和血管纵向缩缝术相结合的方法重建颈内静脉。当晚期口腔癌患者的双侧颈内静脉均与周围可疑癌转移的淋巴结粘连紧密时,可以节段性切除颈内静脉,采用颈外静脉重建颈内静脉,或仅切除部分颈内静脉血管壁;同时对颈内静脉的近心端和远心端纵向缩缝,使静脉管径均匀变化。选择5例接受双侧根治性颈淋巴清扫手术治疗的口腔鳞状细胞癌患者,采用该方法重建颈内静脉,观察手术效果。结果 5例患者术后均未出现因静脉回流不畅导致的面部水肿、咽喉部水肿、脑水肿、颅内高压等严重并发症,未出现颈内静脉栓塞。术后随访5-19个月,采用多普勒或CT血管造影等检查颈内静脉的通畅情况,均未发现栓塞。5例患者的1年生存率为60%（3/5）。结论血管纵向缩缝联合显微血管吻合术是一种有效的处理颈部转移淋巴结累及双侧颈内静脉时的新方法,该方法具有良好的效果及可行性。Objective To seek a new method for reconstructing bilateral internal jugular vein invaded by metastasis lymph node in advanced oral cancer patients. Methods A combination of microvascular anastomosis and longitudinal constriction suture venoplasty was performed to reconstruct internal jugular vein. We resected the part of the bilateral internal jugular vein of advanced oral cancer patients invaded by metastasis lymph node and used the external carotid vein to reconstruct the internal jugular vein. A part of the vessel wall of the internal jugular vein could also be resected to reconstruct the vein. Longitudinal constriction suture venoplasty could slowly narrow the lumen diameter of the internal jugular vein. Thus, difference in anastomosis diameter should be avoided because it generates eddy currents and subsequently causes blood clots. A total of five advanced cases of oral squamous cell carcinoma were involved in this study. We performed bilateral radical neck dissection on all patients to reconstruct the internal jugular vein and observed their postoperative conditions. Results Postoperative follow-up of 5 months to 19 months was performed on all patients. Doppler or CT angiography and related tests showed no internal jugular vein thrombosis. No patient with facial edema, throat swelling, cerebral edema, and high intracranial pressure or other serious complications caused by blocked venous blood was observed. The one-year survival rate of five patients was 60%（3/5）. Conclusion Microvascular anastomosis combined with longitudinal constriction suture venoplasty is a new method for reconstructing internal jugular vein. This method was proved successful and clinically feasible.

关 键 词：静脉纵向缩缝 显微外科 显微血管吻合 颈内静脉 颈淋巴结清扫术 

分 类 号：R739.8[医药卫生—肿瘤]