Abstract：Objective To investigate the efficacy and safety of the great saphenous vein in carotid resection for malignant tumor invasion.Methods This retrospective study included patients who underwent head and neck surgery at the Cancer Hospital of the Chinese Academy of Medical Sciences from November 2017 to September 2019. In particular, this study focused on 18 patients of carotid artery malignant tumor invasion, including 10 males and 8 females, aged 47-72(58.8±6.6)years. Among the patients, 11 patients had papillary thyroid cancer and seven patients had squamous cell carcinoma of head and neck, where five of them underwent radiation therapy before surgery. Combined with a comprehensive preoperative examination, the surgeries comprised the complete removal of the tumor and part of the carotid artery and the reconstruction of the vessel with the autologous saphenous vein. Low-molecular-weight heparin was given after surgery, and computed tomography (CT) angiography and CT were regularly reviewed. The patients were observed with preoperative cervical ultrasound and CT prompt neck round Angle, lower limb venous ultrasound prompted by the great saphenous vein and far away from hui in vein heart to carry 5 cm in diameter, operation time, intraoperative blood loss, not by the side of great saphenous vein transplantation, donor great saphenous vein length, tumor and carotid artery block time package RaoGeng Angle, receptor carotid arterial anastomosis inner diameter, histologic examination results, patients' length of hospital stay, postoperative reconstruction flow situation of the blood vessels, presence of complications in the nervous system and the lower limbs for area, with or without local recurrence and distant metastasis patients during the follow-up period.Results Preoperative ultrasound exploration and neck CT showed that the internal diameter of the great saphenous vein in 18 patients was (0.53±0.14) cm at 5 cm from the distal end of the portal vein. CT scan of the neck showed that the wrapping angle of the tumor to the carotid artery were more than 180°, among which 15 patients were more than 270°, and 9 patients were all wrapped around the carotid artery. The length of saphenous vein was (7.3±1.1) cm. Nine patients were selected from the left great saphenous vein and 9 patients from the right. The proximal carotid anastomosis sites were all common carotid arteries with an internal diameter of (0.74±0.06) cm. The distal anastomosis was located in the common carotid artery in 14 patients and the internal carotid artery in 4 patients, with the internal diameter (0.71±0.17) cm. The time of intraoperative carotid artery occlusion was (640±117) s. The intraoperative invasion angle of carotid artery was observed at 190°- 360° (317°±56°), which was consistent with the preoperative imaging examination. The operation time of 18 patients ranged from 4 to 6 hours, the intraoperative hemorrhage ranged from 200 to 500 mL, and the hospitalization time ranged from 7 to 28 days (mean 13.13 days).Postoperative pathology indicated 13 patients of invasion of carotid vascular wall tissue. The average follow-up time was 11.06(3-24) months. Among the 18 patients, 2 died, and 1 experienced local recurrence, and the remaining 15 survived without tumor. Postoperative carotid artery CT angiography showed that all the reconstructed vessels were unobstructed. No graft vessel rupture, infection, stenosis, and pseudoaneurysm formation were found in all patients during the follow-up period. No edema, claudication, and other complications of blood circulation disorders were observed in the lower limbs of the donor area. Conclusions The autologous great saphenous vein can be used as a donor for carotid artery reconstruction in the surgical treatment of head and neck malignant tumors. Therefore, it is suitable to be widely used because of its easy sampling, low graft infection rate, and low risk of neurological complications.
孙宇, 王晓雷, 张烨, 徐萌. 大隐静脉重建颈动脉在头颈部恶性肿瘤手术治疗中的应用[J]. 中华解剖与临床杂志, 2020, 25(2): 129-134.
Su Yu, Wang Xiaolei, Zhang Ye, Xu Meng. Reconstruction of carotid artery with the great saphenous vein in the surgery of head and neck malignancy. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 129-134.
Chiu CJ, Terzis J, MacRae ML. Replacement of superior vena cava with the spiral composite vein graft. A versatile technique[J]. Ann Thorac Surg, 1974, 17(6): 555-560. DOI:10.1016/s0003-4975(10)65697-4.
[2]
Miao B, Lu Y, Pan X, et al. Carotid artery resection and reconstruction with expanded polytetrafluoroethylene for head and neck cancer[J]. Laryngoscope, 2008, 118(12): 2135-2138. DOI:10.1097/MLG.0b013e318182a50e.
[3]
张志愿, 竺涵光, 孙坚, 等. 颈动脉手术35例临床分析[J]. 中华口腔医学杂志, 2006, 41(1): 25-28. DOI:10.3760/j.issn:1002-0098.2006.01.009.Zhang ZY, Zhu HG, Sun J, et al. Surgery of the carotid artery: a retrospective study of 35 consecutive cases[J]. Chin J Stomatol, 2006, 41(1): 25-28. DOI:10.3760/j.issn:1002-0098.2006.01.009.
[4]
Ballotta E, Renon L, Toffano M, et al. Prospective randomized study on bilateral above-knee femoropopliteal revascularization: polytetrafluoroethylene graft versus reversed saphenous vein[J]. J Vasc Surg, 2003, 38(5): 1051-1055. DOI:10.1016/s0741-5214(03)00608-6.
[5]
黄伟聪, 陆地, 王珏, 等. 冠状动脉旁路移植术大隐静脉分段切开获取与全程切开获取的近期对比[J]. 实用医学杂志, 2017, 33(18): 3067-3069. DOI:10.3969/j.issn.1006-5725.2017.18.022.Huang WC, Lu D, Wang Y, et al. Comparative study of vein graft patency between segmental incision and open saphenous vein harvesting in coronary artery bypass grafting[J]. The Journal of Practical Medicine, 2017, 33(18): 3067-3069. DOI:10.3969/j.issn.1006-5725.2017.18.022.
[6]
穆志杰. 下肢主要静脉的应用解剖分析[J]. 中国继续医学教育, 2016, 8(30): 186-187. DOI:10.3969/j.issn.1674-9308.2016.30.122.Mu ZJ. Application of main vein anatomy[J]. China Continuing Medical Education, 2016, 8(30): 186-187. DOI:10.3969/j.issn.1674-9308.2016.30.122.
[7]
景玉萍. 大隐静脉及其属支的应用解剖观察[J]. 湖北职业技术学院学报, 2012, 15(2): 107-109. DOI:10.3969/j.issn.1671-8178.2012.02.028.Jing YP. Applied anatomy observation of great saphenous vein anal their branches[J]. Journal of Hubei Polytechnic Institute, 2012, 15(2): 107-109. DOI:10.3969/j.issn.1671-8178.2012.02.028.
[8]
Unlü Y, Kele P, Kele S, et al. An evaluation of histomorphometric properties of coronary arteries, saphenous vein, and various arterial conduits for coronary artery bypass grafting[J]. Surg Today, 2003, 33(10): 725-730. DOI:10.1007/s00595-003-2586-3.
[9]
Picquet J, Coiffard C, Pechard M, et al. Anatomical basis of an original pedal approach to the great saphenous vein for surgery[J]. Surg Radiol Anat, 2006, 28(2): 176-179. DOI:10.1007/s00276-005-0057-9.
[10]
丁宝维, 戴良, 夏玉光, 等. 健康成人颈动脉和椎动脉颅外段的超声特征解剖学分析[J]. 解剖学杂志, 2012, 35(5): 645-648, 655. DOI:10.3969/j.issn.1001-1633.2012.05.026.Ding BW, Dai L, Xia YG, et al. Anatomical analysis of ultrasonic features of extracranial portion of the carotid and vertebral arteries in healthy adults[J]. Chinese J Anatomy, 2012, 35(5): 645-648,655. DOI:10.3969/j.issn.1001-1633.2012.05.026.
邓红平, 林一奇, 王之宇, 等. 裤裆式静脉移植在修复四肢大血管损伤中的应用[J]. 中国修复重建外科杂志, 2005, 19(4): 267-269. Deng HP, Lin YQ, Wang ZY, et al. Application of crotch-shaped vein grafts in repairing defects of the vessels with a large diameter[J]. Chinese Journal Reparative and Reconstructive Surgery, 2005, 19(4): 267-269.
Kennedy JT, Krause CJ, Loevy S. The importance of tumor attachment to the carotid artery[J]. Arch Otolaryngol, 1977, 103(2): 70-73. DOI:10.1001/archotol.1977.00780190050002.
[15]
Illuminati G, Schneider F, Minni A, et al. Resection of recurrent neck cancer with carotid artery replacement[J]. J Vasc Surg, 2016, 63(5): 1272-1278. DOI:10.1016/j.jvs.2015.10.098.
[16]
Sessa CN, Morasch MD, Berguer R, et al. Carotid resection and replacement with autogenous arterial graft during operation for neck malignancy[J]. Ann Vasc Surg, 1998, 12(3): 229-235. DOI:10.1007/s100169900145.
[17]
Zhengang X, Colbert S, Brennan PA, et al. Surgical management of metastases that involve the carotid artery in cases of primary squamous cell carcinoma of the head and neck[J]. Int J Oral Maxillofac Surg, 2013, 42(4): 440-445. DOI:10.1016/j.ijom.2012.11.015.
[18]
Urken M, Biller HF, Lawson W, et al. Salvage surgery for recurrent neck carcinoma after multimodality therapy[J]. Head Neck Surg, 1986, 8(5): 332-342. DOI:10.1002/hed.2890080504.
[19]
边学, 徐震纲, 祁永发, 等. 侵及颈动脉的晚期转移头颈鳞状细胞癌的挽救手术[J]. 中华耳鼻咽喉科杂志, 2004, 39(12): 746-750. DOI:10.3760/j.issn.1673-0860.2004.12.011.Bian X, Xu ZG, Qi YF, et al. Salvage surgery for patients with metastatic squamous cell carcinoma involving carotid artery in head and neck[J]. Chin J Otorhinolaryngol, 2004, 39(12): 746-750. DOI:10.3760/j.issn.1673-0860.2004.12.011.
[20]
Katsuno S, Takemae T, Ishiyama T, et al. Is carotid reconstruction for advanced cancer in the neck a safe procedure?[J]. Otolaryngol Head Neck Surg, 2001, 124(2): 222-224. DOI:10.1067/mhn.2001.112482.
[21]
Vargas-Estrada A, Edwards D, Bashir M, et al. Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome[J]. World J Cardiol, 2015, 7(6): 351-356. DOI:10.4330/wjc.v7.i6.351.
[22]
Sabik JF 3rd, Lytle BW, Blackstone EH, et al. Comparison of saphenous vein and internal thoracic artery graft patency by coronary system[J]. Ann Thorac Surg, 2005, 79(2): 544-551. DOI:10.1016/j.athoracsur.2004.07.047.
[23]
胡海地, 冯勇, 张强. 自体静脉移植后血管重塑的动态变化[J]. 中国医科大学学报, 2000, 29(5): 356. DOI:10.3969/j.issn.0258-4646.2000.05.015.Hu HD, Feng Y , Zhang Q , et al. Time course of remodeling of experimental vein grafts[J]. J Chin M ed Univ, 2000, 29(5): 356. DOI:10.3969/j.issn.0258-4646.2000.05.015.
2020, Vol. 25 
