Adams D C, Wood S J, Tulloh B R, Baird R N, Poskitt K R
Department of Vascular Surgery, Cheltenham General Hospital, U.K.
Eur J Vasc Surg. 1992 Sep;6(5):558-62. doi: 10.1016/s0950-821x(05)80633-4.
Thoracic sympathectomy has an established role in the management of primary palmar and axillary hyperhidrosis, Raynaud's phenomenon and occlusive vascular disease. Potential problems with traditional surgical approaches to the sympathetic chain include poor exposure, risk of damage to adjacent structures and postoperative pain. A minimally invasive endoscopic approach helps to overcome these problems. Using this technique, 45 procedures have been performed on 26 patients in two districts in the South West of England over the past five years. Follow-up information was available for 39 procedures. All 27 procedures for hyperhidrosis and both for occlusive vascular disease have produced a long-term improvement. Nine of the 10 procedures for Raynaud's phenomenon have also produced some degree of long-term improvement. Complications included four asymptomatic pneumothoraces, two patients with temporary unilateral Horner's syndrome and two instances of intercosto-brachial numbness. On the positive side, patients expressed satisfaction with the efficacy, rapid recovery and small unobtrusive scars produced by the procedure. Endoscopic transthoracic sympathectomy is effective, safe and well accepted by patients and we believe is now the method of choice for this procedure.
胸交感神经切除术在原发性掌部和腋窝多汗症、雷诺现象及闭塞性血管疾病的治疗中具有既定作用。传统手术方法处理交感神经链存在一些潜在问题，包括暴露不佳、损伤相邻结构的风险以及术后疼痛。微创内镜方法有助于克服这些问题。在过去五年中，运用该技术在英格兰西南部两个地区的26例患者身上进行了45例手术。有39例手术的随访信息。所有27例多汗症手术以及闭塞性血管疾病的手术均取得了长期改善效果。10例雷诺现象手术中有9例也取得了一定程度的长期改善效果。并发症包括4例无症状气胸、2例出现暂时性单侧霍纳综合征以及2例肋间臂神经麻木。积极的方面是，患者对该手术的疗效、快速康复以及留下的微小不显眼疤痕表示满意。内镜下经胸交感神经切除术有效、安全且患者接受度良好，我们认为目前是该手术的首选方法。
