Wilkinson H A
Division of Neurological Surgery, University of Massachusetts Medical School, Worchester, USA.
Neurosurgery. 1996 Apr;38(4):715-25.
Between June 1979 and May 1994, I performed 148 unilateral or bilateral sympathectomies on 247 limbs in 110 patients using a percutaneous radiofrequency technique, usually on an outpatient surgery basis. Patient ages ranged from 10 to 81 years, with 45 male and 65 female patients. Four patients had unsuccessfully undergone prior open surgical sympathectomy. Patients suffered from hyperhidrosis, vascular occlusion, Raynaud's disease or other chronic vasculopathies, painful causalgia or reflex sympathetic dystrophy, or Prinzmetal's angina. The sympathectomy technique has evolved over this 15-year period and is currently in its third phase. Changes in the procedure were based on anatomic and clinical/radiographic correlations and careful patient follow-up. Current modifications have reduced the frequency of both early and late failures. The present technique (Phase III) relies on neuroleptanalgesia with superficial local anesthesia only and does not require general anesthesia, intubation, or lung collapse. Two 18-gauge radiofrequency TIC needle electrodes (Radionics, Burlington, MA) are used. A series of three lesions is rostrocaudally made at each of the ganglion sites selected in an attempt to destroy the entire fusiform ganglion. Lesion sites are targeted by C-arm fluoroscopy and electrical stimulation, which produces a threshold of sensory awareness of > 1.0 V. Lesion effectiveness is monitored by bilateral finger plethysmography and hand skin temperature measurement. With the Phase III technique, the sympathetic activity in 96% of operated limbs after 2 years and in 91% of operated limbs after 3 years continues to be completely or largely interrupted. By comparison, I achieved similar success in 83 and 72% operated limbs with the Phase I technique and in 77 and 71% with the Phase II technique. Symptomatic pneumothorax, in six patients, has been the only serious complication. When necessary, a subsequent operation can easily be performed and is effective.
1979年6月至1994年5月期间，我采用经皮射频技术，通常在门诊手术的基础上，为110例患者的247条肢体进行了148次单侧或双侧交感神经切除术。患者年龄在10至81岁之间，男性45例，女性65例。4例患者此前接受开放性手术交感神经切除术失败。患者患有多汗症、血管闭塞、雷诺病或其他慢性血管病变、疼痛性灼痛或反射性交感神经营养不良，或变异型心绞痛。交感神经切除术技术在这15年期间不断发展，目前处于第三阶段。手术的改变基于解剖学与临床/影像学的相关性以及对患者的仔细随访。目前的改进减少了早期和晚期失败的发生率。当前技术（第三阶段）仅依靠神经安定镇痛加表面局部麻醉，不需要全身麻醉、插管或肺萎陷。使用两根18号射频TIC针电极（Radionics公司，马萨诸塞州伯灵顿）。在选定的每个神经节部位，从尾到头依次制作一系列三个损伤灶，试图破坏整个梭形神经节。通过C形臂荧光透视和电刺激来确定损伤部位，电刺激产生的感觉阈值>1.0V。通过双侧手指体积描记法和手部皮肤温度测量来监测损伤效果。采用第三阶段技术，96%的手术肢体在术后两年以及91%的手术肢体在术后三年的交感神经活动持续完全或大部分被阻断。相比之下，第一阶段技术在83%和72%的手术肢体上取得了类似的成功，第二阶段技术在77%和71%的手术肢体上取得了类似的成功。6例患者出现了有症状的气胸，这是唯一的严重并发症。必要时，后续手术可以轻松进行且有效。
