Paleru Cristian, Dănăilă Olga, Bordîncă Ioana, Istrate Adrian, Bolca Ciprian, Cordoş Ion
Clinica I Chirurgie Toracică, Institutul National de Pneumoftiziologie Marius Nasta Bucureşti.
Pneumologia. 2007 Oct-Dec;56(4):208-10.
Thoracoscopic surgery reduce the morbidity of sympathectomy. Major indications of video-assisted sympathectomy (VAT) include hyperhidrosis, Raynaud's disease, causalgia, and reflex sympathetic dystrophy. Because little information is available in the national and international literature VAT sympathectomy in the treatment of upper extremities ischemia, we decided to present our first case.
The 38 years old patient was hospitalized for left upper-extremity ischemia (Raynaud's syndrome). Thoracoscopic sympathectomy was performed with resection of the main trunk proximally immediately after the stellate ganglion and distally at the level of T4 and identification and resection of 2 collateral branches of the sympathetic chain T2-T3.
The postoperative evolution demonstrated evident clinical benefit. The thermography performed postoperative showed hyperthermia and hyper-vascularization in the left hemithorax with a difference of temperature of 2 degrees C between the two sides of the thorax.
Before the advent of VAT, thoracic sympathectomy was performed only in highly selected patients because of its invasiveness. Now VAT sympathectomy is considered in most cases as the last resort to prevent extensive and successive amputation. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier in the natural course of this disease.
胸腔镜手术降低了交感神经切除术的发病率。电视辅助交感神经切除术（VAT）的主要适应症包括多汗症、雷诺氏病、灼性神经痛和反射性交感神经营养不良。由于国内外文献中关于VAT交感神经切除术治疗上肢缺血的信息较少，我们决定介绍我们的首例病例。
一名38岁患者因左上肢缺血（雷诺氏综合征）住院。胸腔镜交感神经切除术在星状神经节近端立即切除主干，并在T4水平远端进行，同时识别并切除交感神经链T2-T3的2个侧支。
术后病情进展显示出明显的临床益处。术后进行的热成像显示左半胸体温过高和血管过度增生，两侧胸腔温度相差2摄氏度。
在VAT出现之前，由于其侵入性，胸交感神经切除术仅在经过严格筛选的患者中进行。现在，在大多数情况下，VAT交感神经切除术被视为防止广泛和连续截肢的最后手段。由于该手术微创、安全且并发症发生率低，在这种疾病的自然病程中应更早考虑。
