Byrne J, Walsh T N, Hederman W P
Dept. of Surgery, Liandough Hospital, Cardiff, Wales.
Endosc Surg Allied Technol. 1993 Oct-Dec;1(5-6):261-5.
Surgical sympathectomy has traditionally been achieved by 'open' surgical techniques. The transaxillary, cervical, or dorsal approaches have not been without morbidity and cosmetically have been found to be less than ideal. The main indication for sympathectomy in most units is palmar and axillary hyperhidrosis refractory to medical treatment, although it has been used with some success in troublesome causalgia. Use of sympathectomy in Raynaud's disease remains disappointing. In our unit thoracoscopic sympathectomy has been performed since 1980. A CO2 pneumothorax is initially created in the usual manner. This is followed by electrocoagulation of the sympathetic chain under direct vision using a unipolar diathermy. The lung is then reinflated under direct vision. Chest drains are not inserted. Both sides are performed at the same sitting, and the patient usually leaves hospital the following day. The functional and cosmetic results are excellent on short and long term follow-up with few side effects. Permanent Horner's syndrome has not been reported using this technique. As with all upper limb sympathectomies, patients should be warned of possible compensatory hyperhidrosis. Embracing the tenets of minimally invasive surgery, thoracoscopic sympathectomy should be considered the approach of choice for surgical sympathectomy.
传统上，手术交感神经切除术是通过“开放”手术技术来实现的。经腋窝、颈部或背部入路并非没有并发症，而且在外观上也不尽如人意。在大多数科室，交感神经切除术的主要适应症是药物治疗无效的手掌和腋窝多汗症，尽管它在治疗棘手的灼性神经痛方面也取得了一些成功。在雷诺病中使用交感神经切除术仍然令人失望。自1980年以来，我们科室一直开展胸腔镜交感神经切除术。首先以常规方式制造二氧化碳气胸。然后在直视下使用单极透热法对交感神经链进行电凝。然后在直视下使肺复张。不插入胸腔引流管。双侧手术在同一次手术中进行，患者通常在第二天出院。短期和长期随访的功能和美容效果都非常好，副作用很少。使用这种技术尚未报告永久性霍纳综合征。与所有上肢交感神经切除术一样，应告知患者可能出现代偿性多汗症。秉承微创手术的原则，胸腔镜交感神经切除术应被视为手术交感神经切除术的首选方法。
