Mailis A, Chan J, Basinski A, Feindel C, Vanderlinden G, Taylor A, Flock D, Evans D
Toronto Western Hospital Pain Investigation Unit, Ontario, Canada.
Heart Lung. 1989 Nov;18(6):553-8.
During an 18-month period 11 patients were seen at the Toronto Western Hospital Pain Clinic 4 months to 5 years after internal mammary artery (IMA) bypass with a specific cluster of chest wall symptoms and signs confined to the site of IMA graft harvesting. Sympathetic ganglia blocks produced dramatic but temporary relief of symptoms in two of the most severely affected patients. In two other patients seen quite early after surgery, use of transcutaneous electrical stimulation produced considerable and permanent decrease of symptoms within 3 weeks. Such a chronic pain syndrome has not been previously reported in the literature. We postulate that IMA bypass surgery may be associated with a specific pain syndrome. This syndrome may arise from injury to the anterior branches of the intercostal nerves at the site of graft harvesting. Possible neurophysiologic mechanisms are discussed.
在18个月期间，11名患者在多伦多西部医院疼痛诊所就诊，他们在接受乳内动脉（IMA）搭桥手术后4个月至5年，出现了一组特定的局限于IMA移植物获取部位的胸壁症状和体征。交感神经节阻滞在两名受影响最严重的患者中产生了显著但短暂的症状缓解。在另外两名术后早期就诊的患者中，经皮电刺激在3周内使症状显著且永久性减轻。这种慢性疼痛综合征此前在文献中尚未有报道。我们推测IMA搭桥手术可能与一种特定的疼痛综合征相关。该综合征可能源于移植物获取部位肋间神经前支的损伤。文中讨论了可能的神经生理机制。
