Trignano M, Boatto R, Mastino G P, Ferrandu T, Padula G, Loi V, Pala C
Istituto di Patologia Chirurgica, Facoltà di Medicina e Chirurgia, Università degli Studi, Sassari.
Minerva Chir. 2000 Jan-Feb;55(1-2):17-23.
Raynaud's syndrome is a clinical entity characterised by episodic vascular spasm, digital ischemia in response to cold or emotional stimuli and hyperhidrosis. Many patients suffering from Raynaud's syndrome are successfully treated using medical therapy alone. Those patients who do not respond to medical treatment undergo surgery but the indications continue to be a source of controversy. A modern approach to thoracic sympathectomy requires a video-assisted technique. The aim of this study is to attempt to use mini-invasive type surgery to treat Raynaud's disease and hyperhidrosis in order to evaluate the real efficacy of thoracic sympathectomy in a large number of patients. The results of this method were compared for the two different pathologies in question.
The methodology used by this study is based on instrumental and clinical tests performed before and after surgery on treated patients using a comparative criterion and with a minimum 5-year follow-up. The pre- and postoperative diagnostic tests were performed by the vascular surgery laboratory and using a C.W. Doppler and a reflected light photoplethysmograph. Capillaroscopy and laboratory evaluations relating to secondary Raynaud's disease were carried out by internist type structures. The patients enrolled in the study responded to the following criteria: primary Raynaud's disease, palmar hyperhidrosis and associated syndromes. The population came from a mixed sociodemographic background, albeit within a strictly regional zone (Sardinia). A total of 42 patients were studied. The surgical technique used consisted of the ablation of thoracic ganglia from the 2nd to the 4th.
The results showed a resolution of symptoms in 95% of patients treated for hyperhidrosis, whereas a 50% recidivation rate was observed in patients with Raynaud's disease alone, although symptoms were less intense. The results for Raynaud's disease were more disappointing, but it is important to remember that surgery is the ultimate choice for cases with advanced lesions which do not respond to medical treatment. Under these circumstances, the possibility of halting the evolution of the pathology represents an auspicious achievement.
The authors affirm that mini-invasive surgical treatment of hyperhidrosis was resolutive during a mean follow-up of 3 years. It therefore represents a valid method which causes minimum esthetic damage to the patient and the greatest functional benefit. The postoperative period is short (about 3 days) and free of major complications. There is virtually no post-surgical pain.
雷诺综合征是一种临床病症，其特征为发作性血管痉挛、因寒冷或情绪刺激引起的手指缺血以及多汗症。许多雷诺综合征患者仅通过药物治疗就能成功治愈。那些对药物治疗无反应的患者会接受手术，但手术指征仍是一个有争议的问题。现代的胸交感神经切除术需要采用视频辅助技术。本研究的目的是尝试使用微创手术治疗雷诺病和多汗症，以便在大量患者中评估胸交感神经切除术的实际疗效。针对这两种不同病症比较了该方法的结果。
本研究采用的方法基于对接受治疗的患者在手术前后进行的仪器检查和临床测试，采用比较标准，并进行至少5年的随访。术前和术后诊断测试由血管外科实验室进行，使用连续波多普勒和反射光容积描记仪。与继发性雷诺病相关的毛细血管显微镜检查和实验室评估由内科类型的机构进行。纳入本研究的患者符合以下标准：原发性雷诺病、手掌多汗症及相关综合征。研究人群来自社会人口统计学背景各异的群体，尽管都在严格限定的区域内（撒丁岛）。共研究了42例患者。所采用的手术技术包括切除第2至第4胸神经节。
结果显示，95%接受多汗症治疗的患者症状得到缓解，而仅患雷诺病的患者复发率为50%，不过症状较轻。雷诺病的结果更令人失望，但重要的是要记住，对于药物治疗无反应的晚期病变病例，手术是最终选择。在这种情况下，阻止病情发展的可能性是一项值得庆幸的成果。
作者断言，在平均3年的随访期间，微创手术治疗多汗症是有效的。因此，它是一种有效的方法，对患者造成的美学损伤最小，功能益处最大。术后恢复期短（约3天），且无重大并发症。几乎没有术后疼痛。
