颈静脉扩张症的诊治

Diagnosis and treatment of jugular phlebectasia

目的探讨颈静脉扩张症临床诊断和治疗方法。方法回顾性分析13例颈静脉扩张症的临床资料。经Valsalva试验,彩色超声和放射影像学检查,证实颈静脉扩张症的病变性质、程度和范围。除2例上纵隔肿瘤转胸外科治疗外,颈浅静脉瘤切除术5例,介入导管扩张术1例,颈内静脉环形缩缝术1例和口服肠溶阿司匹林保守治疗4例。结果手术治疗7例,无术后并发症,住院2～7d,平均3d,均痊愈出院。7例随访3～32个月,平均14.4月,术后症状无复发,美容效果良好。保守治疗4例,随访3～55个月。无症状3例颈内静脉管腔扩张程度和病变范围无明显变化,有症状1例对症治疗好转。结论对颈前部质软,囊性,可压缩,忽大忽小的肿块,Valsalva试验时增大,应考虑颈静脉扩张症,放射影像学检查可明确病变性质,部位和范围。对有临床症状,影响美容的患者,采用微创手术去除病灶,解除症状,达到美容目的。

Objective To discuss the diagnosis and treatment of jugular phlebectasla. Methods Clinical data of 13 patients with jugular phlebectasia were reviewed. The confirmation of diagnosis in the nature, range, and degree of jugular phlebectasia was made using the Valsalva maneuver, color uhrasonography, and enhancement radiological techniques. Except 2 patients with superior mediastinal tumor were transfered to the Department of Thoracic Surgery, the treatment included resection of phlebangioma in 5 patients, internal jugular vein dilatation by balloon catheter in 1 patient, jugular venoplasty in l patient, and conservative treatment with Aspirin in 4 patients. Results In 7 surgically treated patients, the postoperative recovery was uneventful and no complications occurred. The length of hospital stay was 2- 7 days （ mean, 3 d）. Follow - up observations in the 7 patients for 3 - 32 months （ mean, 14.4 months） found no recurrence and excellent cosmetic outcomes. In 4 patients receiving conservative therapy, follow - up observations were carried out for 3 - 55 months. No changes were observed in 3 asymptomatic patients on the dilatation extent of the internal jugular vein and the range of the lesions, while improvements were achieved in 1 patient with symptoms after symptomatic treatment. Conclusions The diagnosis of jugular phlebectasla should be made for the patients who presented with a soft cystic fluctuant mass on the anterior neck which became more prominent during the Valsalva manoeuvre. The confirmation of differential diagnoses in the nature, range and degree of jugular phlebectasia can be made by enhancement radiological examinations. Minimally invasive surgery is recommended for the patients with symptomatic and cosmetic purposes.