両側全頸部郭清術に際して内頸静脈再建を行った1例

Abstract

Neck dissection contributes not only to controlling the tumors but also to the probability of survival in the treatment of head and neck malignancies. Total neck dissection, which includes ligation and resection of the internal jugular vein, influences cerebral circulatory dynamics. Especially in the case of bilateral total neck dissection, maintenance of cerebral blood-flow is the most important consideration. The patient was a 54-year-old man with gingival carcinoma of the upper jaw. Following preoperative chemotherapy and radiotherapy, partial maxillectomy of the upper jaw and right total neck dissection were performed. Though the primary lesion and ipsolateral neck were controlled by the initial treatment, cervical metastasis surrounding the internal jugular vein of the contralateral side was recognized 2 years after surgery. Angiographs revealed collateral pathway of the right cervical region. However, the amount of blood flow was not sufficient. Left total neck dissection and reconstruction of the internal jugular vein with a femoral vein graft were performed, cohsidering an elevation of intracranial pressure. The grafted vein has remained patent, and there has been no evidence of cerebral complications. The patient has been followed up without recurrence or metas- tasis for 4 years.