Pediatric jugular venous dilatation is a rare congenital venous malformation, which is characterized by dilatation of the jugular veins and the appearance of a mass in the neck when chest pressure increases, such as when coughing, sneezing or crying. Since the veins are dilated and thin-walled, surgical treatment is often required to prevent accidents. From February 1997 to October 2006, we treated 25 cases of jugular venous dilatation, including 20 cases of pediatric jugular venous dilatation, which is reported as follows. 1, data and methods 1.1 General information In this group, there were 20 cases, 15 males and 5 females; age 2 to 11 years old, average 6.8 years old, school-age children were the majority, 16 cases; history of the disease ranged from 3d to 8 years, average 18 months; 18 cases were unilateral, of which 1 case was external jugular vein dilatation and the rest were internal jugular vein dilatation, 17 cases were right-sided, 2 cases were left-sided, and 1 case was bilateral. There was no history of neck trauma. All the children had typical clinical manifestations: when crying or holding their breath with force, the external jugular vein dilatation patients could see obvious superficial vein dilatation in the neck; the internal jugular vein dilatation patients could see a mass at the sternocleidomastoid muscle. When the chest pressure is reduced to normal, the mass can shrink or even disappear. The mass was smooth, cystic, without pulsation or vascular murmur. 8 cases had progressive swelling on the affected side, 5 cases had dizziness, 3 cases had a foreign body sensation on the affected side, 1 case had discomfort when swallowing (no abnormality was seen on pharyngeal examination), 13 cases had a history of good crying in early childhood, and 6 cases had no symptoms because of the impact on beauty. Color Doppler ultrasound and DSA angiography showed that the jugular vein was dilated, which was often more than 1.5 times of the normal size, and the widest width was up to 3.5 cm, especially when the patient performed the Valsalva maneuver, and one case was accompanied by the dilation of the innominate vein. All of the patients in this group underwent angiography or color ultrasound. 1.2 Surgical methods Except for one case of external jugular vein dilatation which was resected, 18 cases in this group used artificial blood vessels to wrap and narrow the dilated internal jugular vein. This method does not need to block the blood flow of the distal internal jugular vein and does not incise the vein. The method is as follows: tracheal intubation with intravenous compound anesthesia; shoulder cushion, neck straightening, head turned to the healthy side by 45°; longitudinal incision along the anterior edge of the sternocleidomastoid muscle, free the internal jugular vein in the internal and posterior part of the sternocleidomastoid muscle; careful incision of the sheath of the vein for the intrathecal separation, ligation of the small vein belongs to the branch, pay attention to deal with the posterior occipital vein, reveal the lesion, and see that the wall of the dilated part of internal jugular vein was abnormally thin, and you could see that the blood flow in the tube in the form of vortex passing through. After the distal and proximal ends of the diseased section of the internal jugular vein were completely separated, an ePTFE artificial blood vessel with a diameter of 1.5 cm and a length of about 5 cm was taken, split longitudinally, wrapped around the diseased section of the vein, trimmed against the normal caliber of the vein, and then sewn into a cylinder shape. 6-0 Prolene non-absorbable suture was used to close the artificial blood vessel and narrow the internal jugular vein to its normal circumference. At the end of the operation, it was fixed with several sutures to the nearby soft tissues. During the operation, the vagus nerve was protected on the right side, and the thoracic duct was protected on the left side. Results: Except for one case of a 2-year-old child who was transferred to Beijing Children’s Hospital for treatment because of the dilatation of anonymous vein, all the patients in this group were cured, and the incision was healed in one stage without infection, subincision hemorrhage, or hematoma formation, and satisfactory results were obtained in the immediate postoperative period, and the limited swelling of neck disappeared when breath was held, and the appearance was good, and there was no postoperative hoarseness of voice, swallowing, or choking cough. In one case, the discomfort of swallowing disappeared soon after surgery, and in three cases, the foreign body sensation in the neck disappeared after 1 month. The follow-up period was from 6 months to 5 years, the average follow-up period was 2.5 years, 2 cases were lost, the follow-up rate was 90% (18/20), all of them recovered well, the preoperative symptoms disappeared, 1 case of incision scar was mildly hyperplasia, the rest of the local appearance was normal, and there was no recurrence of the case. 3,Discussion,Jugular venous dilatation is also known as venous dilatation,venous cyst,venous tumor,etc.Harris was the first to report jugular venous dilatation in 1928.Jugular venous dilatation is commonly found in the jugular veins. Jugular venous dilatation occurs in school-age children and is more common in males. Most of the cases were unilateral lesions, with the right side being more common. 80% (16/20) of the patients in this group were school-age children, 75% (15/20) were males, and 95% (19/20) of the patients had unilateral lesions, with 85% (17/20) having the right side. There were more cases of internal jugular vein dilatation (19 cases) than external jugular vein dilatation (1 case); 13 cases (65%) were crying and grumpy since childhood, and the onset of the disease was considered to be related to the chronic elevated thoracic pressure.La Monte suggested that the distended right pulmonary cusp and clavicular head may have exerted sufficient pressure on the right innominate vein to cause an obstruction, which would temporarily distend and dilate the right internal jugular vein; because the right internal jugular vein is more lateralized than the left internal jugular vein, the right internal jugular vein is more lateralized than the left internal jugular vein, which is more lateralized than the left internal jugular vein. Because the right internal jugular vein is more lateralized than the left internal jugular vein, and the right innominate vein is in direct contact with the right pleura, the disease is more common on the right side. The pathology of the resected specimen has been reported differently in the literature, with some suggesting a normal structure, and others suggesting thinning of the vessel wall and carotid sheath, diffuse fibrosis, lack or reduction of the elastic lamina and absence or reduction of the muscularis propria. Jugular venous dilatation usually presents as a round or pike-shaped soft, cystic mass on one side that shrinks on compression, often appearing when the head is in a low position, when the neck muscles are tightened, or when the voice is exerted, especially when crying, coughing, shouting, singing, or holding the breath hard enough to do the Valsalva maneuver, and disappears in a quiet state. Most of the patients are asymptomatic and only show localized lumps or bumps, but adult patients may have dizziness and neck pain on the affected side. The main diagnostic methods for jugular venous dilatation are angiography and color ultrasound Doppler flowmetry. Color ultrasonography can identify and determine the degree of jugular venous dilatation, the extent of dilatation and the adjacency of the surrounding structures, and can detect the diameter of the jugular vein and the blood flow velocity, with a high degree of accuracy and reproducibility, and it is a better choice for confirming the diagnosis of this disease [4, 5]. Venography and digital subtraction angiography (DSA) can provide clearer vascular images with greater contrast, detect internal jugular vein pressure and blood flow velocity, and objectively assess the size of the internal jugular vein, which is conducive to the selection of surgical procedures. However, venography is an invasive examination, which is not only difficult to operate, but also has complications such as hematoma, perforation, and thoracic catheter injury in the course of the procedure. The data in our group showed that the diagnosis was confirmed by color ultrasound Doppler flow mapping or venography for those who were clinically suspected of having this disease. For asymptomatic patients, whether to follow up conservative treatment or surgery is still controversial. Some scholars believe that early small and asymptomatic masses do not need to be treated urgently and can be followed up for observation [6]. However, we believe that surgery is preferable because a small scar on the neck is better than a neck mass, both from a surgical point of view and from an aesthetic point of view [7]. If the lesion is not removed, there is a possibility of complications such as pulmonary embolism due to thrombosis, hemorrhage due to vessel rupture, and even life-threatening in severe cases. The authors encountered a case of adult jugular vein dilatation rupture and bleeding, which was cured by surgery. Moreover, surgery is easy to perform, safe and effective. The use of surgery to remove dilated veins in external jugular venous dilatation is not objectionable. Some scholars advocate ligation or excision of internal jugular vein in internal jugular vein dilatation [4,8,9]. In this method, the lesion is removed, but the normal local circulatory pathway is altered, and there is a long period of postoperative neck swelling and discomfort, and some patients have transient increased intracranial pressure. However, we adopted the artificial blood vessel package to narrow the internal jugular vein to treat this disease, and received very good results. This method does not change the anatomical path, but only strengthens the weak vein wall, with little trauma, no complications, and fast postoperative recovery [4]. In our group, except for one case of external jugular vein which took the resection method, the rest used this method. After 6 months to 5 years of follow-up, the results were good, and no recurrence cases were seen. Intraoperative freeing of the internal jugular vein should be very careful, because the wall of the dilated vein is very thin, once ruptured, due to the negative pressure in the thoracic cavity can lead to air embolism, which is life-threatening. At the same time, care should be taken not to damage the vagus nerve. If the proximal dilatation reaches the inlet of the subclavian vein, it is not necessary to free the vein too far downward, just above the inlet. Care should also be taken not to injure the left internal jugular vein or the posterior thoracic duct when freeing the proximal end of the left internal jugular vein. The PTFE prosthetic vessels without reinforcement rings are strong, histocompatible, thin, and have no foreign body sensation, and do not affect their appearance. The use of non-absorbable prolene sutures maintains the strength over time. The disadvantage of this method is that some patients may have foreign body sensation and neck discomfort in the short term. In our group, 3 cases had foreign body sensation in the neck after surgery, which disappeared after 1 month, 1 case had mild hyperplasia of the incision scar, and the rest of the patients had no complication. The authors believe that surgical treatment is appropriate in the following cases: (1) aesthetic considerations require surgical treatment; (2) the mass continues to grow and affects the appearance; (3) the patient is depressed; (4) there are serious symptoms and complications, such as dizziness, headache, and jugular thrombosis, etc. The author believes that conservative treatment is suitable for the following cases. Conservative treatment is suitable for the following cases: (1) the mass is not large and without any symptoms; (2) there is local inflammation or infection, and surgery is not suitable for the time being; (3) there are serious cardiovascular and cerebral and other major organs, and those who can not tolerate surgery. Jugular venous dilatation is a benign disease, generally does not affect health. However, with its increasing size, it affects the aesthetics, and most of the patients are young children and adolescents, who are less capable of self-protection and self-control, and are at risk of injury and rupture, while surgery is not traumatic and the risk is small, etc., and after diagnosis, the patients who have large masses or accompanying symptoms and those who have a heavy burden of thought should be actively treated with surgery[10] . In our case, we used artificial vascular wrapping to reduce the caliber of the vein to normal without removing the enlarged part of the vein. This surgical method is easy and safe to operate, with good immediate results, but the long-term effect needs to be observed by accumulating cases and following up.