Aljehani Yasser, Alhouri Atteia, Turkistani Alaa, ShahBahai Rahma, AlQatari Abdullah A
Division of Thoracic Surgery, Department of General Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Division of Rheumatology, Department of Internal Medicine, Qatif Central Hospital, AlQatif, Saudi Arabia.
Int J Surg Case Rep. 2020;75:203-206. doi: 10.1016/j.ijscr.2020.08.041. Epub 2020 Aug 31.
Secondary Raynaud's is a manifestation that can present in CREST syndrome as a variant of five different diseases: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Secondary Raynaud's presents as a result of an imbalance between vasoconstriction and vasodilation potentially leading to tissue ischemia. The mainstay treatment is medical while surgery treatment preserved as a last resort.
A 28-year-old female presented with secondary Raynaud's and was subsequently diagnosed with CREST syndrome. The patient failed to respond to medical treatment, and gangrene of the right fourth distal phalanx developed. Stellate ganglion block was successfully used as a bridge to surgery. Uniportal video-assisted thoracoscopic surgery (VATS) sympathectomy was performed via a 2-cm incision, the sympathetic ganglia were identified and transected by cauterization at the level of the 3rd, 4th, and 5th intercostal spaces extending for a distance of 5 cm to ensure that the nerve of Kuntz was transected. The postoperative outcome was satisfactory, and the condition of the patient improved in a few months.
Different management modalities have been used to relieve the symptoms of secondary Raynaud's. The treatment ranges from lifestyle modification, medical treatment, and lastly surgical intervention. Sympathectomy has been suggested for the management of refractive secondary Raynaud's owing to its considerable clinical response.
The use of uniportal VATS sympathectomy results in favorable cosmetic and clinical outcomes including reduced length of hospital stay and postoperative pain.
继发性雷诺现象是CREST综合征的一种表现形式，CREST综合征是五种不同疾病的变体，即钙质沉着、雷诺现象、食管动力障碍、指（趾）硬皮病和毛细血管扩张。继发性雷诺现象是血管收缩和舒张失衡的结果，可能导致组织缺血。主要治疗方法是药物治疗，手术治疗则作为最后手段。
一名28岁女性出现继发性雷诺现象，随后被诊断为CREST综合征。该患者药物治疗无效，右手中指末节指骨发生坏疽。星状神经节阻滞成功用作手术的过渡治疗。通过一个2厘米的切口进行单孔电视辅助胸腔镜手术（VATS）交感神经切除术，在第3、4和5肋间水平识别并烧灼切断交感神经节，延伸5厘米以确保切断Kuntz神经。术后效果满意，患者病情在几个月内得到改善。
已采用不同的治疗方式来缓解继发性雷诺现象的症状。治疗方法包括生活方式改变、药物治疗，最后是手术干预。由于交感神经切除术有显著的临床反应，已被建议用于治疗难治性继发性雷诺现象。
单孔VATS交感神经切除术具有良好的美容和临床效果，包括缩短住院时间和减轻术后疼痛。
