Watarida S, Shiraishi S, Fujimura M, Hirano M, Nishi T, Imura M, Yamamoto I
Second Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Shiga, 520-2192, Japan.
Surg Endosc. 2002 Mar;16(3):500-3. doi: 10.1007/s00464-001-8206-7. Epub 2001 Nov 16.
The standard procedure for sympathectomy is open surgery. The oblique retroperitoneal approach is popular because it provides good visibility, albeit at the expense of requiring a long skin incision. Chemical sympathectomy has been introduced as a less invasive means of achieving sympatholysis; however, this method is also associated with a significant incidence of incomplete block and transient denervation. Laparoscopic surgery is a new approach that simplifies various surgical procedures. The aim of our report was to evaluate the benefits of endoscopic retroperitoneal surgery for lumbar sympathectomies.
Between March 1997 and April 2000, seven patients underwent laparoscopic lumbar sympathectomy in our department (all men, with an average age or 45.1 years). The predominant presenting symptoms were unilateral pain at rest and lower-extremity coldness. Symphaectomy was performed using a retroperitoneal approach on six patients and an anterior transperitoneal approach on one patient. After laparoscopic lumbar sympathectomy, skin thermometry was carried out on all patients.
The postoperative skin temperature of the affected leg rose to 36.6 +/- 0.5 degrees C, as compared to 33.8 +/- 0.8 degrees C preoperatively. After laparoscopic lumbar sympathectomy, none of the patients complained of neuralgia. All patients achieved sustained symptomatic relief, and no major postoperative complications were noted.
Lumbar sympathectomy can be performed laparoscopically. Currently, our standard technique is the retroperitoneal approach. More clinical experience and long-term follow-up will ultimately determine if this will become the procedure of choice. However, we believe that a learning period is necessary for this technique to be fully mastered.
交感神经切除术的标准术式是开放手术。腹膜后斜切口入路很常用，因为它视野良好，尽管代价是需要较长的皮肤切口。化学性交感神经切除术已作为一种侵入性较小的实现交感神经松解的方法被引入；然而，该方法也存在不完全阻滞和短暂去神经支配发生率较高的问题。腹腔镜手术是一种简化各种外科手术的新方法。我们报告的目的是评估内镜下腹膜后手术治疗腰交感神经切除术的益处。
1997年3月至2000年4月期间，我们科室有7例患者接受了腹腔镜腰交感神经切除术（均为男性，平均年龄45.1岁）。主要表现症状为单侧静息痛和下肢发冷。6例患者采用腹膜后入路进行交感神经切除术，1例患者采用经腹前入路。腹腔镜腰交感神经切除术后，对所有患者进行了皮肤温度测量。
患侧术后皮肤温度升至36.6±0.5℃，术前为33.8±0.8℃。腹腔镜腰交感神经切除术后，无一例患者主诉神经痛。所有患者均获得持续的症状缓解，未发现重大术后并发症。
腰交感神经切除术可通过腹腔镜进行。目前，我们的标准技术是腹膜后入路。更多的临床经验和长期随访最终将决定这是否会成为首选术式。然而，我们认为要完全掌握这项技术需要一个学习期。
