Di Lorenzo N, Sica G S, Sileri P, Gaspari A L
Cattedra di Chirurgia Generale, Università di Roma, Tor Vergata, Italy.
JSLS. 1998 Jul-Sep;2(3):249-53.
Vasospastic disorders (acrocyanosis, Raynaud's syndrome, causalgia) can arise from different etiologic factors, but the pathogenesis is always represented by an altered mechanism of vasal motility. Upper dorsal sympathectomy has been demonstrated to be an effective treatment for these disorders by decreasing peripheral resistances. Surgical technique has shown long-lasting results, and it can now be performed by endoscopic approach.
Our experience with six cases of sympathectomy is illustrated. The indications, thoracoscopic technique, complications and long-term results are evaluated. Four women with Raynaud's syndrome and two men with causalgia were treated in this series. After an accurate preoperative evaluation, the second, third, fourth and fifth thoracic ganglia of the sympathetic chain were identified and excised.
All patients experienced relief of symptoms with very limited pain and discomfort. They did not require further medical therapy and are relapse-free at follow-up.
We conclude that thoracoscopic sympathectomy can be considered an effective, safe and simple treatment for selected cases of vasospastic phenomenon.
血管痉挛性疾病（手足发绀症、雷诺综合征、灼性神经痛）可由不同病因引起，但其发病机制总是表现为血管运动机制改变。上胸交感神经切除术已被证明是通过降低外周阻力治疗这些疾病的有效方法。手术技术已显示出长期效果，现在可通过内镜方法进行。
阐述了我们6例交感神经切除术的经验。评估了手术指征、胸腔镜技术、并发症和长期效果。本系列治疗了4例雷诺综合征女性患者和2例灼性神经痛男性患者。经过准确的术前评估后，识别并切除交感神经链的第二、第三、第四和第五胸神经节。
所有患者症状均得到缓解，疼痛和不适非常有限。他们无需进一步药物治疗，随访期间无复发。
我们得出结论，胸腔镜交感神经切除术可被认为是治疗某些血管痉挛现象病例的有效、安全且简单的方法。
