Plas E G, Függer R, Herbst F, Fritsch A
Department of Surgery, University of Vienna, Austria.
Surgery. 1995 Sep;118(3):493-5. doi: 10.1016/s0039-6060(05)80364-2.
Endoscopic resection of the thoracic sympathetic trunk has been performed in various diseases of the upper limb. The success rates in endoscopic techniques and open surgical procedures are reportedly between 95% and 100%. However, the incidence of complications varied significantly depending on the technique used. We report our experience with complications after endoscopic resection of the thoracic sympathetic trunk.
To evaluate the complications of endoscopic thoracic sympathectomy, we retrospectively investigated 412 patients operated on since 1965. In 412 patients 698 procedures had been performed: a bilateral trunk resection in 81.9%, right thoracic sympathectomy in 12.9%, and left sympathetic trunk resection in 5.2%.
Complications demanding intervention were found in 2.7% of the procedures, and in 9.7% complications not indicating active therapy were seen. In all cases requiring intervention a pneumothorax that needed to be drained was found on postoperative x-ray film. An asymptomatic small apical pneumothorax was found in 4.4%, cutaneous emphysema in 2%, pleural effusion in 1.1%, and segmental atelectasis in 0.4% of the procedures. One case of bleeding from an intercostal vessel occurred (0.1%). A permanent Horner's ptosis was seen in 1.7% of the patients.
The endoscopic resection of the thoracic sympathetic trunk is a safe and minimally invasive procedure with a low complication rate. We believe that endoscopic sympathectomy should be preferred to open surgical procedures.
内镜下胸交感神经干切除术已应用于上肢的多种疾病。据报道，内镜技术和开放手术的成功率在95%至100%之间。然而，并发症的发生率因所采用的技术不同而有显著差异。我们报告内镜下胸交感神经干切除术后并发症的经验。
为评估内镜下胸交感神经切除术的并发症，我们回顾性研究了自1965年以来接受手术的412例患者。412例患者共进行了698次手术：双侧神经干切除术占81.9%，右侧胸交感神经切除术占12.9%，左侧交感神经干切除术占5.2%。
2.7%的手术出现需要干预的并发症，9.7%出现无需积极治疗的并发症。在所有需要干预的病例中，术后X线片显示有需要引流的气胸。4.4%的手术出现无症状的小尖顶气胸，2%出现皮下气肿，1.1%出现胸腔积液，0.4%出现节段性肺不张。发生1例肋间血管出血（0.1%）。1.7%的患者出现永久性霍纳氏上睑下垂。
内镜下胸交感神经干切除术是一种安全、微创且并发症发生率低的手术。我们认为内镜下交感神经切除术应优先于开放手术。
