【摘要】 目的探索颈清扫术中不同方式颈静脉结扎对颅内压和脑胶质细胞的影响,寻找较理想的结扎方式。方法60只日本大耳兔随机分为对照组、双侧颈外静脉结扎组、双侧颈内静脉结扎组、右侧颈静脉结扎组、同期双侧颈静脉结扎组、分期颈静脉结扎组,经颅顶钻孔于术后0h、0.5h、1.0h、2.0h、3.0h、4.0h、5.0h、6.0h测量ICP值;一周后取兔大脑组织,切片,免疫组织化学法染色,观察脑胶质细胞数目和面积大小。结果同期双侧颈静脉结扎组和分期颈静脉结扎组术后颅内压升高快,达到峰值后下降缓慢,6h仍维持在较高水平,尤以同期双侧颈静脉结扎组显著;对照组术后6h内颅内压无明显变化;双侧颈外静脉结扎组术后颅内压轻度升高,6h后基本恢复至术后0h水平;双侧颈内静脉结扎组和右侧颈静脉结扎组术后颅内压有一定程度升高,但术后6h已有明显下降;双侧颈外静脉结扎组、双侧颈内静脉结扎组、右侧颈静脉结扎组脑胶质细胞数目及面积与对照组无明显差异,而同期双侧颈静脉结扎组、分期颈静脉结扎组脑胶质细胞明显增生和肥大。结论同期结扎双侧颈静脉和分期结扎颈静脉后,术中、术后必须采取预防颅高压的处理;结扎双侧颈内静脉和结扎右侧颈静脉术中、术后应观察病情变化;结扎双侧颈外静脉的患者术后无须降颅内压处理。更多还原

【Abstract】 Objective To investigate the effects of different jugular vein ligations (JVL) in neck dissection on intracranial pressure (ICP) and glial cell in rabbit.Methods Sixty rabbits were equally and randomly divided into 6 groups: control (BC), bilateral external jugular vein ligation (BEJVL), bilateral internal jugular vein ligation (BIJVL), right jugular vein ligation (RJVL), simultaneous bilateral jugular vien ligation (SBJVL), and staging jugular vein ligation (SJVL). Skull puncture technique was employed to measure the values of ICP at 0h, 0.5h, 1h, 2h, 3h, 4h,5h,6h postoperation. Necephalic tissue was removed a week after the surgery. The quantity and area of glial cells were examined with immunohistochemistry.Results ICP in SBJVL and SJVL was increased immediately and still maintained highly at 6h postoperatively, while ICP was increased slightly first and then back to the baseline within 6h postoperatively. ICP in BIJVL and RJVL, was increased to some extent and decreased apparently within 6h postoperatively. The quantity and hypertrophy of glial cells were only significantly increased in SBJVL and SJVL.Conclusion Measurements should be taken to prevent intracranial hypertension in SBJVL and SJVL, while close watch should be taken in BIJVL and RJVL. It may require no special measurement to prevent intracranical hypertension in BEJVL.更多还原