Applicationg Of Reconstruction Of Carotid Artery With Great Saphenous Vein In The Surgery Of Head And Neck Malignancy

Objective:To evaluate the safety of great saphenous vein reconstruction in patients with head and neck malignant tumor with carotid artery invasion,and to explore the influence of reconstruction data on the prognosis of patients.Methods:A retrospective analysis of 20 cases of head and neck cancer patients with carotid artery invasion in the head and neck surgery department of Cancer Hospital of Chinese Academy of Medical Sciences from November 2017 to November 2019 was conducted,including 11 cases of papillary thyroid carcinoma(55%);There were 7 cases of head and neck squamous cell carcinoma(45%),including 2 cases of hypopharyngeal squamous cell carcinoma,2 cases of laryngeal squamous cell carcinoma,1 case of buccal squamous cell carcinoma,1 case of tongue base squamous cell carcinoma,1 case of maxillary sinus squamous cell carcinoma,and 2 cases of papillary thyroid carcinoma with squamous cell carcinoma.The perioperative period and follow-up of the patients were analyzed,and the influence of the data on the prognosis of the patients was analyzed.Data included:primary or recurrent tumor and metastasis;The diameter of the great saphenous vein of the donor,the number of its branches,the presence or absence of variation,and the disease;The angle of carotid artery invasion,the extent of resection and the diameter of anastomotic stoma were measured;The time of carotid artery occlusion during operation;Postoperative vital signs,neurological complications,donor site lower limb complications;The invasion of carotid artery wall;The patients were followed up.Results:The operation process of 20 patients was smooth,and there was no hemorrhage,rupture and infection during hospitalization.No severe neurological complications such as stroke and hemiplegia occurred in all patients.One case(5%)developed upper limb dysfunction and poor muscle strength on the first day after operation,and improved after five days.There was no edema,claudication and other lower extremity blood circulation and functional changes in donor site.The minimum diameter of the donor great saphenous vein was 0.33cm.The follow-up time was 6-30(15.4 4.5)months±76)months.During the follow-up period,6 patients(30%)died.The main cause of death was distant metastasis(66.67%),and 4 patients(20%)had local recurrence.Conclusion:The great saphenous vein can be used as a donor vessel for carotid artery reconstruction,with the characteristics of easy access,suitable anatomical structure and low infection rate.Carotid artery reconstruction surgery can be used in patients with head and neck malignant tumor invading the carotid artery,and can completely remove the tumor with low risk of neurological complications.