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目的探讨不同方式颈静脉结扎对颅内压(ICP)的影响,寻找较理想的结扎方式,为临床颈清扫术提供理论依据。方法采用日本大耳兔作为实验对象,设立对照组(BC组)、双侧颈外静脉结扎组(BEJVL组)、双侧颈内静脉结扎组(BIJVL组)、右侧颈内、外静脉结扎组(RJVL组)、同期双侧颈内、外静脉结扎组(SBJVL组)、分期颈内、外静脉结扎组(SJVL组),经颅顶钻孔于术后0、0.5、1.0、2.0、3.0、4.0h分别测量ICP值;1周后取兔大脑组织行苏木精伊红染色,观察脑胶质细胞数目及面积大小。结果BC组术后4h内ICP无明显变化;BEJVL组术后ICP轻度升高,4h后基本恢复至术后0h水平;BIJVL组和RJVL组术后ICP有一定程度升高,但术后4h已有明显下降;SBJVL组和SJVL组术后ICP升高快,达到峰值后下降缓慢,术后4h仍维持在较高水平,尤以SBJVL组显著;BEJVL组、BIJVL组、RJVL组脑胶质细胞数目及面积与BC组比较无明显改变;而SBJVL组、SJVL组脑胶质细胞明显增生和肥大。结论临床上,结扎双侧颈外静脉的患者术后无须作降ICP处理;结扎双侧颈内静脉和结扎右侧颈内、外静脉的患者,术中、术后应密切观察病情变化;同期结扎双侧颈内、外静脉和分期结扎颈内、外静脉的患者,术中、术后必须采取预防颅内高压的处理措施。
Objective To investigate the effect of different modes of jugular vein ligation on intracranial pressure (ICP) and to search for an ideal ligation mode to provide a theoretical basis for clinical neck dissection. Methods Rabbit was used as experimental group. The control group (BC group), bilateral external jugular vein occlusion group (BEJVL group), bilateral internal jugular vein occlusion group (BIJVL group), right internal jugular vein and external vein occlusion (RJVL group), bilateral internal carotid and external ligation group (SBJVL group), internal and external carotid artery ligation group (SJVL group) at the same time, 3.0, 4.0h ICP were measured; 1 week after the rabbit brain tissue hematoxylin-eosin staining to observe the number of glial cells and the size of the area. Results There was no significant change in ICP within 4 hours after operation in BC group. The ICP level increased slightly in BEJVL group and returned to 0h level after 4 hours. The ICP level in BIJVL group and RJVL group increased to some extent, but after 4 hours (P <0.05). The ICP increased rapidly in SBJVL group and SJVL group after operation, and then decreased slowly after reaching the peak value. It maintained at a high level 4h after operation, especially in SBJVL group. In BEJVL group, BIJVL group and RJVL group, There was no significant change in number and area of cells compared with BC group; while in SBJVL group and SJVL group, glial cells proliferated and hypertrophy. Conclusions Clinically, patients with bilateral external jugular vein need not be given ICP treatment after operation; patients with bilateral jugular vein ligation and ligation of the right internal carotid artery and external vein should be closely observed intraoperatively and postoperatively. In the same period Ligation of both sides of the internal carotid and external vein and staged ligation of the internal and external venous patients, intraoperative and postoperative must take measures to prevent intracranial hypertension.