Goyal Vikas Deep, Gupta Bharti, Kumar Sanjeev, Pal Sanjay
Department of Cardiothoracic and Vascular Surgery, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
Department of Anesthesia, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
Lung India. 2015 Jan-Feb;32(1):73-5. doi: 10.4103/0970-2113.148458.
A 57-year-old male patient suffering from Buerger's disease presented with pre-gangrenous changes in right foot and ischemic symptoms in right hand. Computed tomographic angiography revealed diffuse distal disease not suitable for vascular bypass and angioplasty. Right lumbar sympathectomy was done using a retroperitoneal approach followed 1 year later by right thoracic sympathectomy using a transaxillary approach. Postoperatively, the patient had severe bronchospasm and excessive secretions in the respiratory tract resistant to theophylline and sympathomimetic group of drugs and without any clinical, laboratory and radiological evidence of infection. The patient was started on anticholinergics in anticipation that sympathectomy might have lead to unopposed cholinergic activity and the symptoms improved rapidly. The patient recovered well and was discharged on 10(th) post-operative day.
一名患有血栓闭塞性脉管炎的57岁男性患者，右脚出现坏疽前期变化，右手有缺血症状。计算机断层血管造影显示弥漫性远端病变，不适合血管搭桥和血管成形术。采用腹膜后入路进行了右侧腰交感神经切除术，1年后采用经腋窝入路进行了右侧胸交感神经切除术。术后，患者出现严重支气管痉挛，呼吸道分泌物过多，对茶碱和拟交感神经药物耐药，且无任何感染的临床、实验室和影像学证据。考虑到交感神经切除术可能导致胆碱能活性不受抑制，开始给予患者抗胆碱能药物治疗，症状迅速改善。患者恢复良好，术后第10天出院。
