Ahn S S, Machleder H I, Concepcion B, Moore W S
UCLA Center for the Health Sciences.
J Vasc Surg. 1994 Oct;20(4):511-7; discussion 517-9. doi: 10.1016/0741-5214(94)90275-5.
The purpose of this study was to determine the feasibility, safety, and efficacy of thoracoscopic cervicodorsal sympathectomy.
From March 1990 to December 1993, we performed 21 thoracoscopic sympathectomies in 19 patients. There were 13 women and six men; age 17 to 64 years, mean 37 years. Thirteen procedures were performed on the left side and eight on the right. Indications for surgery were causalgia/reflex sympathetic dystrophy in nine patients, Raynaud's/vasculitis in six, hyperhidrosis in five, and medically refractory cardiac arrhythmia in one.
The T1-4 sympathetic ganglia were readily identified, dissected free, and resected thoracoscopically in 19 cases, and the T3-7 ganglia were resected with thoracoscopy in one case. One case required conversion to an open thoracotomy because of dense scar from a previous first rib resection, which obscured the anatomy. Histologic confirmation of ganglia were obtained in all 21 cases. Operative duration ranged from 1.0 to 3.5 hours. Estimated blood loss was 5 to 300 cc, mean 42 cc, median 10 cc. No patient required transfusion. All 21 patients had an excellent immediate sympathectomy response. Transient Horner's syndrome developed in two patients. Postoperative residual pneumothorax (< 10%) occurred in three cases and resolved spontaneously without further treatment. In one patient pleural effusion and pneumothorax developed, which were treated with the reinsertion of the chest tube. Postoperative pain was well controlled with oral analgesics. Hospital stay was 1 to 4 days, mean 2 days, median 1 day. Follow-up at 1 to 42 months, mean 11 months, median 6 months, showed continued evidence of sympathectomy effect in all patients, except one who died of her underlying disease 1 month after operation.
We conclude that thoracoscopic sympathectomy is feasible, safe, and effective. Further studies are indicated to confirm its long-term benefits and to determine optimal thoracoscopic techniques.
本研究的目的是确定胸腔镜下颈胸交感神经切除术的可行性、安全性和有效性。
1990年3月至1993年12月，我们对19例患者实施了21例胸腔镜交感神经切除术。其中女性13例，男性6例；年龄17至64岁，平均37岁。13例手术在左侧进行，8例在右侧进行。手术适应证为9例灼性神经痛/反射性交感神经营养不良、6例雷诺氏病/血管炎、5例多汗症以及1例药物治疗无效的心律失常。
19例患者经胸腔镜顺利识别、游离并切除了T1 - 4交感神经节，1例患者经胸腔镜切除了T3 - 7神经节。1例患者因既往第一肋骨切除后形成的致密瘢痕使解剖结构不清，需转为开胸手术。所有21例均获得神经节的组织学证实。手术时间为1.0至3.5小时。估计失血量为5至300毫升，平均42毫升，中位数为10毫升。无患者需要输血。所有21例患者术后立即出现了良好的交感神经切除反应。2例患者出现了短暂性霍纳综合征。3例患者发生了术后残余气胸（< 10%），未经进一步治疗自行缓解。1例患者出现了胸腔积液和气胸，经重新置入胸管治疗。术后疼痛通过口服镇痛药得到良好控制。住院时间为1至4天，平均2天，中位数为1天。随访1至42个月，平均11个月，中位数为6个月，结果显示除1例术后1个月因基础疾病死亡外，所有患者均持续存在交感神经切除效果的证据。
我们得出结论，胸腔镜交感神经切除术是可行、安全且有效的。需要进一步研究以证实其长期益处并确定最佳的胸腔镜技术。
