Matsumoto Yasushi, Ueyama Takeshi, Endo Masamitsu, Sasaki Hisao, Kasashima Fuminori, Abe Yoshinobu, Kosugi Ikuko
Department of Cardiovascular Surgery, National Kanazawa Hospital, Japan.
J Vasc Surg. 2002 Jul;36(1):57-61. doi: 10.1067/mva.2002.123330.
For many years, thoracic sympathectomy via open surgery was not used to treat Raynaud's phenomenon because of the invasiveness of this procedure and the poor long-term outcomes associated with it. However, with the introduction of endoscopic surgery, thoracic sympathectomy (or sympathicotomy) has been performed by some surgeons as a less invasive surgical option for patients with Raynaud's phenomenon. The less invasive procedure has the possibility of emphasizing merits of sympathectomy. The purpose of this study was to reevaluate the efficacy of sympathicotomy for Raynaud's phenomenon with endoscopic technique and its range of applicability.
Between December 1992 and August 2001, endoscopic thoracic sympathicotomy (ETS) was performed in 28 patients with Raynaud's phenomenon (of a total of 502 patients with autonomic disorders who underwent ETS) at National Kanazawa Hospital. We considered indications for surgical treatment of Raynaud's phenomenon to include severe chronic symptoms or nonhealing digital ulceration refractory to intensive medical therapy. All patients were mailed a self-assessment questionnaire after surgery to determine the immediate and long-term results of the procedure. Data from both initial and long-term follow-up examinations were obtained.
Fifty-four ETS procedures were performed in 28 patients. No operative mortality was seen, and no occurrence of major complications necessitated open surgery. Initial resolution or improvement of symptoms was achieved in 26 of 28 patients (92.9%). However, later in the postoperative period, symptoms recurred in 23 of 28 patients (82.1%), although no recurrence of digital ulceration was seen throughout our observation. At the final follow-up examination (median follow-up period, 62.5 months), 25 patients (89.3%) reported overall improvement of the frequency and severity of their symptoms.
Despite the high rate of recurrence, ETS clearly produced a high rate of initial relief. ETS did indeed promote healing of digital ulcers, and the procedure shows potential for reducing the severity of refractory symptoms. We consider ETS to be the method of choice for treatment of severe or refractory Raynaud's phenomenon, and especially for Raynaud's involving digital ulcer, because of its safety and efficacy.
多年来，由于开放性手术的侵入性以及与之相关的不良长期预后，经开放手术进行胸交感神经切除术未被用于治疗雷诺现象。然而，随着内镜手术的引入，一些外科医生已将胸交感神经切除术（或交感神经切断术）作为雷诺现象患者侵入性较小的手术选择。这种侵入性较小的手术有可能突出交感神经切除术的优点。本研究的目的是重新评估内镜技术下交感神经切断术治疗雷诺现象的疗效及其适用范围。
1992年12月至2001年8月期间，金泽国立医院对28例雷诺现象患者（在总共502例接受内镜胸交感神经切断术的自主神经功能障碍患者中）实施了内镜胸交感神经切断术（ETS）。我们认为雷诺现象的手术治疗指征包括严重的慢性症状或强化药物治疗难以治愈的手指溃疡。所有患者术后均收到一份自我评估问卷，以确定该手术的近期和长期结果。获取了初始检查和长期随访检查的数据。
28例患者共进行了54次ETS手术。未观察到手术死亡，也未发生需要进行开放手术的重大并发症。28例患者中有26例（92.9%）症状最初得到缓解或改善。然而，在术后后期，28例患者中有23例（82.1%）症状复发，尽管在我们的观察期间未见到手指溃疡复发。在最后一次随访检查时（中位随访期为62.5个月），25例患者（89.3%）报告其症状的频率和严重程度总体有所改善。
尽管复发率较高，但ETS确实产生了较高的初始缓解率。ETS确实促进了手指溃疡的愈合，并且该手术显示出减轻难治性症状严重程度的潜力。由于其安全性和有效性，我们认为ETS是治疗严重或难治性雷诺现象，尤其是伴有手指溃疡的雷诺现象的首选方法。
