Jeng J S, Yip P K, Huang S J, Kao M C
Department of Neurology, National Taiwan University Hospital, Taipei.
J Neurosurg. 1999 Mar;90(3):463-7. doi: 10.3171/jns.1999.90.3.0463.
The purpose of this study was to analyze the change in carotid and middle cerebral artery (MCA) hemodynamics before and after endoscopic upper thoracic sympathectomy in patients with palmar hyperhidrosis (PH).
Sixty-eight patients with PH (35 males and 33 females) for whom the average age was 24.5+/-10.7 years (+/- standard deviation) were recruited into this study. These patients all underwent routine upper T-2 sympathectomy to treat their PH. Ultrasonography studies of the carotid arteries (CAs) and MCA were obtained in each patient before and after T-2 sympathectomy. The blood flow volume, flow velocity, and resistivity index (RI) in the bilateral common CAs (CCAs), internal CAs (ICAs), and external CAs (ECAs) were evaluated using duplex ultrasonography. The systolic peak velocity, mean velocity, diastolic peak velocity, pulsatility index, and RI of the bilateral MCAs were evaluated using transcranial Doppler ultrasonography. Blood pressure and heart rate were also recorded during this study. The Student paired t-test was used to analyze the differences between studies before and after bilateral T-2 sympathectomy. There was a significant reduction in diastolic pressure after T-2 sympathectomy (p = 0.003), but not in systolic pressure or heart rate. The vessel diameter was increased after sympathectomy in the left CAs and right CCA. The T-2 sympathectomy led to significant elevation of blood flow volume and RI in the left CCA, ICA, and ECA (p < 0.05). The authors found significant increases in maximum flow velocity and RI in the left MCA (p < 0.05).
Patients who underwent T-2 sympathectomy demonstrated a significant increase in blood flow volume and flow velocities of the CAs and MCA, especially on the left side. Asymmetry of sympathetic influence on the hemodynamics of the CAs and MCA was noted. The usefulness of sympathectomy for the treatment of ischemic cardiovascular and cerebrovascular disease deserves further investigation.
本研究旨在分析手掌多汗症（PH）患者内镜下上胸交感神经切断术前后颈动脉和大脑中动脉（MCA）血流动力学的变化。
本研究纳入了68例PH患者（35例男性和33例女性），平均年龄为24.5±10.7岁（±标准差）。这些患者均接受了常规的T-2上胸交感神经切断术以治疗其PH。在T-2交感神经切断术前后，对每位患者进行颈动脉（CAs）和MCA的超声检查。使用双功超声评估双侧颈总动脉（CCAs）、颈内动脉（ICAs）和颈外动脉（ECAs）的血流量、流速和阻力指数（RI）。使用经颅多普勒超声评估双侧MCA的收缩期峰值流速、平均流速、舒张期峰值流速、搏动指数和RI。在本研究期间还记录了血压和心率。采用配对t检验分析双侧T-2交感神经切断术前后各项指标的差异。T-2交感神经切断术后舒张压显著降低（p = 0.003），但收缩压和心率无明显变化。交感神经切断术后左侧CAs和右侧CCA的血管直径增加。T-2交感神经切断术导致左侧CCA、ICA和ECA的血流量和RI显著升高（p < 0.05）。作者发现左侧MCA的最大流速和RI显著增加（p < 0.05）。
接受T-2交感神经切断术的患者CAs和MCA的血流量和流速显著增加，尤其是左侧。注意到交感神经对CAs和MCA血流动力学影响的不对称性。交感神经切断术治疗缺血性心脑血管疾病的有效性值得进一步研究。
