Robertson D P, Simpson R K, Rose J E, Garza J S
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
J Neurosurg. 1993 Aug;79(2):238-40. doi: 10.3171/jns.1993.79.2.0238.
Sympathetic nerve disorders of the upper extremities can be treated by neurosurgeons using upper thoracic sympathectomy via a posterior approach. Descriptions have been published of alternative endoscopic procedures involving thermocoagulation, laser coagulation, or nonvideo-assisted ganglionectomy using equipment not widely available, with low morbidity and excellent results. The authors describe the use of an endoscopic approach to the thoracic sympathetic ganglia with systems designed for laparoscopic cholecystectomy. Thoracic ganglionectomy is reported in 22 patients with primary palmar hyperhidrosis and eight patients with reflex sympathetic dystrophy. The patients underwent double-lumen endotracheal intubation, after which 11- and 5.5-mm trocars were introduced into the chest cavity. Pneumothorax was produced with CO2 insufflation. Fiberoptic closed-circuit television was used to visualize the structures to be dissected. The parietal pleura over the heads of the first and second ribs was excised using 5-mm blunt and sharp insulated coagulating microscissors. The stellate and upper thoracic ganglia were clearly identified and dissected. The T-2 and T-3 ganglia were grasped with forceps and excised. A No. 16 French chest tube was introduced through a trocar, placed under water seal after the lungs were reinflated, and removed in the recovery room. The average hospital stay was 15.4 hours. There were no intraoperative complications. The average operating time was 30 minutes per side. Five patients had mild pleuritic pain which resolved within 2 weeks after surgery. Six (75%) of the eight patients with reflex sympathetic dystrophy had complete or partial relief of their symptoms (average follow-up period 5 months), and all patients had complete relief of hyperhidrosis (average follow-up period 8 months). Endoscopic ganglionectomy requires readily available and easily used instrumentation and provides a well-tolerated, cost-effective alternative to posterior thoracic sympathectomy for primary palmar hyperhidrosis and reflex sympathetic dystrophy.
上肢交感神经紊乱可由神经外科医生通过后路进行胸上段交感神经切除术来治疗。已有文献描述了其他内镜手术，包括热凝、激光凝固或使用不太普及的设备进行非视频辅助神经节切除术，这些手术发病率低且效果良好。作者描述了使用专为腹腔镜胆囊切除术设计的系统对胸交感神经节进行内镜手术的方法。报告了22例原发性手掌多汗症患者和8例反射性交感神经营养不良患者接受胸段神经节切除术的情况。患者接受双腔气管插管，之后将11毫米和5.5毫米的套管针插入胸腔。通过二氧化碳充气造成气胸。使用纤维光学闭路电视来观察待解剖的结构。用5毫米钝头和尖头绝缘电凝显微剪切除第一和第二肋骨头上方的壁层胸膜。清晰识别并解剖星状神经节和胸上段神经节。用钳子夹住并切除T-2和T-3神经节。通过一个套管针插入一根16号法国胸管，肺复张后置于水封下，并在恢复室取出。平均住院时间为15.4小时。术中无并发症。平均手术时间为每侧30分钟。5例患者有轻度胸膜炎性疼痛，术后2周内缓解。8例反射性交感神经营养不良患者中有6例（75%）症状完全或部分缓解（平均随访期5个月），所有患者多汗症均完全缓解（平均随访期8个月）。内镜下神经节切除术需要易于获得和使用的器械，为原发性手掌多汗症和反射性交感神经营养不良提供了一种耐受性良好、性价比高的替代后路胸交感神经切除术的方法。
