Utjecaj sternokleidomastoidnoga mišića na protočnost unutarnje jugularne vene nakon disekcije vrata

doctoral thesis

• Author: Damir Sauerborn
• Mentor: Mihajlo Virag (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2017-06-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Klasicna radikalna disekcija vrata je metoda kojom se odstranjuje limfni sustav
vrata zajedno sa unutarnjom jugularnom venom, akcesornim živcem te
sternokleidomastoidnim mišicem (SCM) zbog lijecenja i kontrole metastatske bolesti u
vratu. Suvremeno shvacanje disekcije vrata podrazumijeva cuvanje svih važnijih
anatomskih struktura u vratu u svrhu smanjenja morbiditeta i povecanja kvalitete života.
Brojne su prednosti cuvanja unutarnje jugularne vene tijekom disekcije, iako
jednostrano podvezivanje vene nije popraceno znacajnijim morbiditetom. Cuvanjem
vene produžuje se operativni zahvat dok je u mnogim radovima opisana tromboza vene
u kasnijem postoperativnom tijeku (od 0 do 30% slucajeva). U dosadašnjim radovima
opisani su razliciti faktori koji mogu dovesti do tromboze unutarnje jugularne vene.
Temeljitom analizom dostupne literature, na pocetku našeg istraživanja, nije na�ena niti
jedna studija koja uzima u obzir cuvanje ili žrtvovanje SCM u odnosu na pojavu
tromboze unutarnje jugularne vene. U ovom prospektivnom istraživanju usporedili smo
utjecaj cuvanja i žrtvovanja SCM na protocnost i pojavu tromboze unutarnje jugularne
vene nakon disekcije vrata. Tako�er smo analizirali utjecaj postoperativne radioterapije
i mikrovaskularne rekonstrukcije na protocnost i pojavu tromboze unutarnje jugularne
vene nakon disekcije. U studiju je ukljuceno ukupno 70 unutarnjih jugularnih vena koje
su podijeljene u 2 skupine. U prvoj skupini imali smo 47 slucajeva kod kojih je ucinjena
selektivna ili modificirana radikalna disekcija sa cuvanjem SCM, dok smo u drugoj
skupini imali 23 slucaja kod kojih je ucinjena selektivna ili modificirana radikalna
disekcija sa žrtvovanjem SCM. Za mjerenje protocnosti korišten je Doppler ultrazvuk i
to neposredno prije operacije (1. mjerenje), 1 do 2 tjedna nakon operacije (2. mjerenje),
3 do 4 mjeseca nakon operacije (3. mjerenje) i 9 do 12 mjeseci nakon operacije (4.
mjerenje). Analizom dobivenih rezultata utvrdili smo znacajno manji broj tromboza u
skupini sa cuvanim SCM. Najveci broj tromboza nastao je u ranom postoperativnom
periodu. U postoperativnom pracenju došlo je do ponovne uspostave protocnosti u
velikom broju tromboziranih vena. Brzine protoka nisu se znacajnije mijenjale.
Volumni protok je bio znacajno niži u ranom postoperativnom periodu u obje skupine te
se postupno oporavljao u obje skupine. Postoperativna radioterapija i mikrovaskularna
rekonstrukcija nisu utjecale na pojavu tromboze, na promjene brzine protoka niti na
promjene volumnog protoka u obje skupine.

Abstract (english)

Classic radical neck dissection is a procedure that removes all lymphatic tissue of
the neck together with internal jugular vein, accessory nerve and sternocleidomastoid
muscle (SCM) for treatment and control of metastatic disease in the neck. Modern
perception of the neck dissection includes preservation of all important neck structures
with the purpose of minimizing morbidity and increasing quality of life. There are
numerous advantages of preservation of internal jugular vein during neck dissection,
although unilateral ligation of the vein is not associated with severe morbidity.
Preservation of vein prolongs surgical procedure while, in many studies, vein becomes
thrombotic in postoperative period (from 0 to 30% of cases). According the literature,
many different factors may cause internal jugular vein thrombosis. After a literature
review, at the beginning of our study, we did not find any study that relates internal
jugular vein thrombosis to preservation or sacrifice of SCM.
In this prospective study, we compared preservation and sacrifice of SCM
according to patency and thrombosis of the internal jugular vein after neck dissection.
We also analysed influence of postoperative radiotherapy and microvascular
reconstruction on internal jugular vein patency and thrombosis after neck dissection. We
included 70 internal jugular veins that were divide in 2 groups. The first group included
47 cases with selective or modified radical neck dissection and preservation of the
SCM, while second group included 23 cases with selective or modified radical neck
dissection and resection of the SCM. For measurement of patency we used Doppler
ultrasound, with first measurement being preoperative, second measurement 1 to 2
weeks postoperative, third measurement 3 to 4 months postoperative and fourth
measurement 9 to 12 months postoperative. In our analysis, we found significant lower
proportion of thrombosis in the group with preserved SCM. Major number of
thrombosis occurred in the early postoperative period. In follow up, large number of
thrombosed veins underwent recanalization. Flow speed did not change significantly.
Flow volume was significantly lower in early postoperative period in both groups and
recovered in postoperative period in both groups. Postoperative radiotherapy and
microvascular reconstruction did not have impact on thrombosis, change of flow speed
and flow volume in both groups.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:834372
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 90 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 07:57:54