Guérin J C, Demolombe S, Brudon J R
Service de Pneumologie, Hôpital de la Croix-Rousse, Lyon.
Rev Mal Respir. 1990;7(4):327-30.
Thoracic sympathectomy is achieved using the trans-axillary route during the course of a thoracotomy. The indications are Raynaud's phenomenon, digital arteriopathy, and hyperhidrosis. Alongside the surgical approach in theory it is possible to use a thoracoscopic approach for a thoracic sympathectomy, to achieve a physico-chemical destruction, we have studied this possibility using this technique.
Thoracoscopy is achieved under local anaesthetic after creating a pneumothorax. The approach is through the 2nd intercostal space in the mid-clavicular line. Anaesthesia of the 2nd sympathetic ganglion is achieved, the ganglion is destroyed by injection of 8 c.c's of Phenol. 15 patients were treated (15 to 7). The presented with palmar hyperhidrosis (7), digital arteriopathy (6) or Raynaud's syndrome (2).
The first 5 patients were failures which led to a more precise technique. Overall we observed 8 favourable results. If we exclude the first 5 cases we achieved 8 favourable results and 2 failures. The approach to the 2nd sympathetic ganglion using the thoracoscope is not always possible: the vision may be obscured. When it is possible phenolization may yield excellent results comparable to those of surgical sympathectomy.
Palmar hyperhidrosis for which we have obtained the best results seems to us to be an extra indication of this technique which enables a cure at the price of a relatively simple procedure and a brief period of hospital stay.
在开胸手术过程中，经腋窝途径可完成胸交感神经切除术。其适应症为雷诺现象、指动脉病变和多汗症。理论上，除了手术方法外，还可以采用胸腔镜方法进行胸交感神经切除术，以实现物理化学性破坏，我们已使用该技术研究了这种可能性。
在制造气胸后，于局部麻醉下进行胸腔镜检查。手术入路为锁骨中线第2肋间。对第2交感神经节进行麻醉，通过注射8毫升苯酚破坏该神经节。共治疗15例患者（年龄15至7岁）。这些患者表现为手掌多汗症（7例）、指动脉病变（6例）或雷诺综合征（2例）。
前5例患者手术失败，促使我们采用更精确的技术。总体而言，我们观察到8例良好结果。如果排除前5例，我们取得了8例良好结果和2例失败。使用胸腔镜到达第2交感神经节并非总是可行：视野可能会受到遮挡。当可行时，酚化可能产生与手术交感神经切除术相当的优异结果。
手掌多汗症是我们获得最佳效果的病症，在我们看来，这是该技术的一个额外适应症，该技术能够以相对简单的手术和较短的住院时间实现治愈。
