Clinical Study On Surgical Treatment Of Jugular Vein Phlebectasia In The Children

Background:Jugular vein phlebectasia (JVP), a rare disease, has more frequently been seen in recent years and more attention from the clinicians. The underlying mechanism, ideal timing of surgery and surgical outcomes are still not clear. With our knowledge and research on JVP deepening, more and more research papers have been published. This section is to analysis the latest status to improve clinical application.Objective:To realize the latest advance and development status of the subject, and analysis the current situation to give the future study help and guidance.Methods:Selected all the related papers about jugular vein phlebectasia which were enlisted in national knowledge infrastructure(CNKI) from1979to2012. Selected the literature review which came from the core journals, screened out the treatises. The treatment of jugular vein phlebectasia were ananlyzed statistically.Results:There were126papers and83teatises about jugular vein phlebectatsia(JVP) were enlisted in CNKI, and45papers were enlisted by core Chinese journals from1979to2012. There were26core papers study on the treatment of jugular vein phlebectasia(JVP), included314surgical cases (lesion resection(164), Enveloping operation (97), longitudinal plication of phlebectasia(20), veno-plasty(5)).Conclusions:Surgical treatment of JVP was considered as the most effective methods. Different operation have their own pros and cons. Ligation resection of the lesion is simple. But ipsilateral neck and craniofacial swelling might appeared soon after the operation. Envelopment of jugular vein avoid blocking the jugular vein. But the suitable material was hard to find. Longitudinal placation of phlebectasia is high technical requirement and veno-plasty is small applicable scope. The doctor should choose surgical interventions according to different conditions in order to obtain excellent results. Background:The underlying mechanism, ideal timing of surgery and surgical outcomes of JVP are still not clear. Different operation have their own pros and cons. Analysis and summary of the latest surgical treatment, we have developed a new method for treating the disease----multipoint hoop operation to make up the lack of others.Objective To investigate the characteristics and surgical treatment for jugular vein phlebectasia in the children.Methods A retrospective analysis was performed in15children of jugular vein phlebectasia from August2005to October2010. Among15children (13male,2female), the ages ranged from2to10years with an average of7.2years. The dilatation involved left internal jugular vein in1, right internal jugular vein in12and bilateral in2. To analysis the clinical characteristics、diagnosis、treatment and follow-up of JVP. Results There were10operations use the method of multipoint hoop of phlebectasia, and7patients use the way of biological material to encapsulation the phlebectasia.The incision length in multiponint grop was less than those of the envelopment group(4.15±1.04vs5.14±1.23). There Was significant difference between two groups (P<0.05). The average operative time, the rate of the complications, the intraoperative blood loss and postoperative hospital stay had no significant difference(82.5±28.69vs76.43±41.08, Ovs0,10±10.47vs8.57±7.4,5.12±1.48vs4.42±1.91, P>0.05). All of the children were discharged with healing.1patiens after the the enveloping opertation with slight discomfort or foreign body sensation. The complaints such as swelling or pain during deglutition, hoarseness disappeared. And there was no intracranial hypertension symptoms such as headache and vomiting. By the petition letter and outpatient service,11children(6multipoint hoop of phlebectasia,7biological material to encapsulation the phlebectasia) were followed up for10months to5years with an average of2years. All of the children were discharged with healing. Postoperative ultrasound studies showed a successful repair of the previous ectasia of the jugular vein. Children were healed well after the multipoint hoop of phlebectasia. Because the thickness of the biological patch is about0.2-0.3cm, the children’s neck was little higher than the other side after the encapsulation.Conclusions Jugular vein phlebectasia (JVP), a rare cervical vasculopathy, was lack of specific clinical manifestations and high rate of misdiagnosis. B-ultrasound or CDFI, combining with the Valsalva’s breathing test, could confirm the diagnosis of JVP. And it was clarity, safety, and low cost. Ligation or excision of the dilation jugular vein was very simple, and effective for most patients. But in cases of the right and bilateral internal jugular veins, multipoint hoop of phlebectasia might be more preferable. It might be more simple and comfortable, and should be recommended for jugular vein phlebectasia. Furthermore, the procedure can keep a normal flow of the vessel, reduce complications, especially in the bilateral cases.