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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: To evaluate the function of the internal jugular vein (IJV) after selective regional neck dissection in patients with head and neck malignancy by color Doppler sonography. Methods: 40 patients (76 IJVs) with oropharyngeal and laryngeal squamous cell carcinoma undergoing unilateral or bilateral neck dissection were divided into two groups according to the range of surgical dissection: group A Ⅱ, Ⅲ, Ⅱ, Ⅲ, Ⅲ, Ⅲ, Ⅲ, Ⅳ, Ⅳ, Ⅳ and Ⅳ, respectively. All patients underwent ultrasonography to detect the presence or absence of thrombosis, expiratory flow, expiratory diameter, expiratory and nostril breath area, and flow rate of IJV before and 1, 3 months after surgery. The results were statistically analyzed. Results: ①There was no thrombosis of IJV in preoperative and postoperative 76 sides. ② The IJV patency rate was 85.5% and 96.1% at 1 and 3 months postoperatively respectively. There was no significant difference between A and B groups (P > 0.05) .③After 1 month after operation, the other indexes in group A and B except for the velocity of pinching the nasal and air during the operation were significantly different from those before operation (all P <0.05) (P <0.05). Compared with preoperation, the other indexes in group A and B were significantly lower than those in group A and B (All P <0.05). (4) There was no significant difference in IJV indexes between different operation scopes (all P> 0.05). Conclusion: ①There is no thrombosis of IJV after selective regional neck dissection, which shows that intraoperative meticulous operation, correct operation skills and appropriate postoperative management can prevent IJV thrombosis; ②IJV indicators in the selection of regional neck dissection Early postoperative changes, but at 3 months after the majority of indicators have been restored, expiratory flow can be restored to the preoperative level, indicating a longer period of time after IJV can return to normal reflux function.