First Discipline of Surgical Semiology, First Department of Surgery, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
Clinic of Thoracic Surgery, Emergency Clinical Municipal Hospital, Timisoara, Romania.
Histol Histopathol. 2022 Oct;37(10):999-1006. doi: 10.14670/HH-18-515. Epub 2022 Aug 5.
Chronic post-thoracotomy pain (PTPS) is a frequent complication of thoracic operations. Sometimes the pain is excruciating enough to impair activities of daily living (ADL). All thoracic procedures have the potential to cause trauma to the intercostal nerves due to retractor use, chest closure techniques, and or wound healing. In our study, we analyzed the microscopic aspects of the nerves involved in the healing process, to better understand the histopathology of chronic pain.
29 patients with PTPS underwent intercostal neurectomy to alleviate the symptoms. Microscopic specimens harvested during the surgeries were sent to our pathology unit for evaluation. The following data regarding the surgical procedures was collected: surgical approach, chest closure type, number of excised nerves, and time interval from previous surgery to neurectomy.
A mean of 2.34±1.11 nerves were excised. Microscopy of the specimens revealed: fibrosis, hyalinization of the epineurium and perineurium, intense hyperemia of the blood capillaries, and interstitial edema. 7 cases presented with myxoid degeneration of epineurium and perineurium. In all the cases, endoneurium, myelin sheaths, and axons were interrupted. The endoneurium showed the presence of hyperemic dilated capillaries. The segmental cytoplasmic vacuolization of Schwann's cells with the total disappearance of axons was also noted. 60% of the examined specimens had intraneural myxoid degeneration, with highly dense irregular connective tissue around nerve fibers.
The pathologic findings in the structure of the intercostal nerves obtained from the patients are indicative of the involvement of the wound healing mechanisms in PTPS. The negative impact of wound healing could be considered a key component in the development of intense chronic pain.
慢性开胸术后疼痛（PTPS）是胸部手术后的常见并发症。有时疼痛剧烈到足以影响日常生活活动（ADL）。由于牵开器的使用、胸部关闭技术和/或伤口愈合，所有胸部手术都有可能对肋间神经造成创伤。在我们的研究中，我们分析了参与愈合过程的神经的微观方面，以更好地了解慢性疼痛的组织病理学。
29 例 PTPS 患者接受肋间神经切除术以缓解症状。手术中采集的微观标本送到我们的病理科进行评估。收集了以下关于手术程序的数据：手术入路、胸部关闭类型、切除的神经数量以及从上次手术到神经切除术的时间间隔。
平均切除 2.34±1.11 根神经。对标本进行显微镜检查显示：纤维化、神经外膜和神经内膜的玻璃样变性、毛细血管强烈充血和间质水肿。7 例表现为神经外膜和神经内膜黏液样变性。在所有病例中，神经内膜、髓鞘和轴突均中断。神经内膜显示出充血扩张的毛细血管。雪旺氏细胞的节段性细胞质空泡化伴有轴突的完全消失也被注意到。检查的标本中有 60%存在神经内黏液样变性，神经纤维周围有高度密集的不规则结缔组织。
从患者获得的肋间神经结构的病理发现表明，伤口愈合机制参与了 PTPS。伤口愈合的负面影响可被认为是剧烈慢性疼痛发展的关键因素。
