化学性胸交感神经节切除术治疗雷诺病

目的 探讨化学性胸交感神经节切除术治疗雷诺病。方法 用腰麻穿刺针在第1或2胸椎棘突旁开5cm处穿刺,以25度角向椎体正中前进,直至针尖抵住椎体。回抽如无血液、脑脊液或空气抽出。病人保持不动,透视并拍X片,确定针尖位于椎体前外侧后,注射1ml造影剂,证实造影剂不向胸腔内泄漏,即注入5％石碳酸2ml后,拔出穿刺针。结果 2例患者双手均于术后5min转红转暖,冰水试验转阴。结论 化学性胸交感神经节切除术操作简单,损伤极小,费用低,是治疗雷诺病的有效方法。     

胸腔镜视下双侧胸交感神经干切断治疗原发性手汗症的临床分析

目的 总结在胸腔镜视下行双侧胸交感神经干切断术治疗手汗症的临床经验并分析其可行性.方法 2006年至2010年,在胸腔镜视下行双侧部分胸交感干切断术治疗手汗症23例.在胸腔镜视下电灼切断胸交感神经干(胸2～胸3),每3个月随访,以掌侧皮肤温度较术前升高1℃以上及干燥温暖为有效,手掌皮肤温度较术前增加小于1℃且仍潮湿者为无效.结果 23例患者术后手掌多汗症状立即消失,4例有背部或足底轻度代偿性出汗,无中度及以上代偿性多汗或其余严重并发症.术后随访时间为3个月至3年,平均18个月,无手汗复发,全部有效.结论 胸腔镜视下交感神经干切断术是一种治疗手汗症的安全有效的方法,且不难为手外科医师所掌握.     

改良L2交感神经节毁损术治疗晚期癌性腰腿痛

晚期癌性腰腿痛患者疼痛剧烈,给患者带来极大的痛苦和生活质量的下降,镇痛药物难以达到预期效果。交感神经切除术被认为是缓解神经痛最有效的治疗手段之一,化学性腰交感切除术（CLS）可取得与手术切除腰交感神经相类似的结果,但传统的CLS需行多节毁损,在腰交感神经节中L2的作用最为重要,单毁损L2交感神经节便可达到理想疗效。     

经胸腔镜切除左胸交感神经治疗先天性QT间期延长综合征

目的 探讨经电视胸腔镜切除左胸交感神经治疗先天性QT间期延长综合征的方法和效果。方法 4例患者,采用双腔插管全身麻醉,在左胸壁做2～3个长1．5cm套管切口,经胸腔镜行左侧部分胸交感神经链切除或夹闭,范围包括星状神经节下1／3及T2～T5神经链。结果 4例患者的校正QT间期平均值由术前的537．5ms缩短至术后的512．5ms,其中3例较术前明显缩短。平均心率较术前无明显变化。术后1例患者出现一过性霍纳综合征;术后4个月1例症状复发,但频率明显降低,β受体阻滞剂加量后缓解。结论 经胸腔镜切除左胸交感神经治疗先天性QT间期延长综合征,创伤小、疗效可靠;但确切的效果尚有待大宗病例进一步证实。     

应用胸腔镜微创技术行胸交感神经切断术治疗手汗症

目的探讨应用胸腔镜微创外科技术治疗手汗症的可行性及临床效果。方法回顾分析1997年3月至2004年7月应用胸腔镜微创手术器械施行胸部交感神经切断术治疗手掌多汗症16例临床资料，总结其方法及临床应用价值。结果手术全部成功，术后双手立即干燥、红润。手术时间平均25min，住院平均3．8d，术后无并发症发生。术后随访1个月～5年，偶见有躯干代偿性多汗，但症状轻微，患者无心理负担。结论胸腔镜微创外科技术胸交感神经切除术能准确有效处理胸交感神经链，是治疗手汗症有效方法。     

化学性腰交感神经切除术治疗下肢缺血性疾病的评价

虽然腰交感神经切除术在肢体缺血性疾病的外科治疗中占有很重要的位置 ,但化学性腰交感神经切除术 (ｃｈｅｍｉ ｃａｌｌｕｍｂａｒｓｙｍｐａｔｈｅｃｔｏｍｙ ,ＣＬＳ) ,也称腰交感神经灭活术 ,更以其操作简单、损伤小、对病人条件要求较低、术后效果与手术腰交感神经切除术相同而逐渐推广。一、化学性腰交感神经切除术的操作方法病人取侧卧位 ,患侧在上 ,按腰交感神经节封闭的方法 ,用两根细长穿刺针在第 2、3或第 3、4腰椎棘突旁穿刺 ,使针尖位于椎体前侧方。然后拍腰椎正侧位平片 ,确定针尖确实位于椎体前外侧后 ,分别注射 6.7%石炭酸…     

胸腔镜下胸交感神经切除术治疗手汗症110例

目的 评价胸腔镜下胸交感神经切除术(TES)治疗手汗症的疗效及并发症。方法 采用胸腔镜下胸交感神经切除术治疗手汗症110例，均采用两侧胸交感神经链同一体位下一期切除。结果 手术有效率100％，术后住院时间1—7天，平均3．2天，所有病例术后双手立即干燥、红润。随访82例(74．5％)，随访时间1—75个月，平均35个月。3例术后再发手掌多汗，但较术前明显减轻，且有逐渐减少趋势。并发症：肺大泡破裂1例，术后气胸7例，单侧轻微Horner综合征2例，胸腔积血1例，鼻炎1例，45例术后出现躯体部代偿性多汗，部分患者术后感觉胸背部疼痛。结论 TES治疗手汗症疗效确切，安全可靠，但应考虑到可能发生的副作用、并发症，仍须严格掌握适应证。     

CT引导定位下化学性胸交感神经节切除术治疗雷诺现象

目的探讨CT定位下化学性胸交感神经节切除术（chemical thoracic sympathectomy，CTS）治疗上肢雷诺现象的有效性和安全性。方法对10例雷诺现象，包括4例X线定位下CTS术后复发患者，在cT定位下经皮穿刺于T2或T3交感神经节处注射5％酚，每个点注射3ml。结果治疗后效果优10条，良3条，改善4条，无效3条，治疗有效率为85．0％（17／20）。原发性雷诺现象有效率为92．9％（13／14），继发性雷诺现象的有效率为66．7％（4／6），复发后治疗有效率为75．0％（6／8）。未发生气胸。结论CT定位下CTS创伤小，有效率高，复发后再次治疗多数仍然有效，是目前治疗上肢雷诺现象较理想的方法。     

二孔法胸腔镜下T_3胸交感神经链切断术治疗手汗症(附52例报告)

目的总结二孔法胸腔镜下T3胸交感神经链切断术治疗手汗症52例的临床经验。方法 2006年8月～2008年12月采用电视胸腔镜T3胸交感神经链切断术治疗手汗症。以掌侧皮肤温度较术前升高1～3℃以上及干燥温暖为有效,手掌皮肤温度较术前增加(1℃且仍为潮湿者为无效。结果 52例手术均获成功,术后患者手掌多汗症状消失,有效率为100%,术后掌温升高(2.6±0.7)℃。50例随访1.5～24个月,平均14.5月,无一例复发及严重代偿性多汗,轻度代偿性多汗6例,占12%(6/50)。结论二孔法电视胸腔镜下T3胸交感神经链切断术是治疗手汗症微创、安全和有效的方法 。     

胸腔镜下胸交感神经干切断术的临床研究(附200例报告)

目的总结胸腔镜胸交感神经干切断术200例的临床经验.方法分析2003年1月～2005年4月经胸腔镜胸交感神经干T2～T4切断术治疗手汗症的临床资料.结果200例手术均获成功,术后患者手掌多汗症状消失,双手转为干燥温暖状,术后掌温升高(3.1±0.9)℃;192例术后随访1～28个月,平均18.4月,无一例复发,术后转移代偿性多汗52例(27.1%).结论胸交感神经干切断术是治疗手汗症安全、微创和有效的方法.     

Thoracoscopic Dorsal Sympathectomy for Upper Limb Buerger's Disease

Background and Objectives:

Thromboangiitis obliterans is a common peripheral vascular disease in India. This study was conducted to assess the efficacy of thoracoscopic dorsal sympathectomy as a treatment for Buerger disease of the upper extremities.

Methods:

Thirty thoracoscopic dorsal sympathectomies (17 left- and 13 right-sided) were performed in a tertiary medical center in 5 women and 20 men (mean age, 41 years) between July 2010 and February 2013.

Results:

The mean operative time was 30 minutes, and the mean hospital stay was 52 hours. There were no complications. All patients had improvement in pain and were relapse-free after a mean follow-up period of 11.63 months.

Discussion:

Thoracoscopic dorsal sympathectomy reduces pain significantly by reducing peripheral resistance and promoting collateral development. The increased magnification of the thoracoscopic approach permits better visualization, ensuring complete excision and therefore good results. Thoracoscopic dorsal sympathectomy for Buerger disease of the upper limb is a safe and effective treatment.     

腹腔非胃手术后功能性胃排空障碍

本报告我院近10年来腹部非胃手术后胃排空障16例共18例次。此症病因尚不清楚，是一种复杂的胃肠功能紊乱。表现为腹部手术后3。4天进食后出现腹胀、恶心、呕吐和胃肌肉无张力。对药物治疗反映不明显。胃肠减压、营养支持和维持水电平衡，耐心等待最终均可恢复，本组均经保守治疗21-74天得以恢复。     

胸腔镜下T3胸交感神经切断术治疗手汗症62例临床分析

目的探讨胸腔镜下T3胸交感神经切断术治疗手汗症的疗效。方法 2008年7月～2011年3月对62例手汗症行胸腔镜下经操作孔电凝钩切断T3胸交感神经及可能存在的交通支。结果 62例手术均获成功,手术时间(双侧)19～36 min,平均24.3 min。住院3～6 d,平均4.5 d。术后出现胸腔积液9例,4例行胸腔穿刺抽液,5例经保守治疗治愈。56例术后随访3～12个月,平均7.2月,2例复发轻度手汗,3例出现轻度代偿性出汗。结论胸腔镜下T3胸交感神经切断术治疗手汗症疗效确切,不易复发,术后代偿性多汗发生率低,安全性高。     

Sympathectomy for complex regional pain syndrome

BACKGROUND: With the easier and earlier recognition of complex regional pain syndrome (CRPS), a reappraisal of its therapy, particularly the role and timing of sympathectomy, is warranted. PATIENTS AND METHODS: Over a 9-year period, 42 patients with CRPS type II of the upper extremity were referred for sympathectomy. Patients were categorized according to the duration of the symptoms (group I, <3 months; group II, >3 months). All patients underwent initial medical treatment; stellate ganglion blocks were performed when symptoms persisted beyond 6 weeks. Patients were referred for thoracoscopic sympathectomy on persistence of the pain syndrome. A visual linear analogue scale was used to evaluate outcome of sympathectomy. RESULTS: Thoracoscopic dorsal sympathectomy was successfully undertaken in 32 patients. In the remaining 10 patients, thoracoscopy was not technically feasible and open sympathectomy was performed. There was an overall improvement in all 42 patients undergoing sympathectomy (P <.001, Wilcoxon signed rank test). The outcome in group I was significantly better than in group II (P <.003, Mann-Whitney U test). The diagnosis of sympathetically mediated pain with stellate blockade did not correlate with clinical outcome. Patients undergoing thoracoscopic sympathectomy had a better outcome than those undergoing open sympathectomy. There were no complications, and the hospital stay was shorter in the thoracoscopic group. CONCLUSION: Early recognition of CRPS and prompt recourse to surgical sympathectomy is a useful option in the management of CRPS.     

化学性腰交感神经切除术治疗下肢缺血性疾病

腰文感神经切除术在治疗下肢动脉闭塞性疾病方面起着重要作用。但手术创伤较大,术后并发症及死亡率较高,尤其是伴有脑或冠心病的患者难以耐受。1991年以来,我们采用了化学性腰交感神经切除术治疗7例下肢缺血性疾病,5例(71.4％)获满意效粟,特别是对雷诺氏病患者可收到立杆见影的效果。本法具有操作简单、损伤小及易于被患者接受等优点,值得推广。     

A 7-year Experience with Thoracoscopic Sympathectomy for Critical Upper Limb Ischemia

Background Severely symptomatic arterial insufficiency of an upper limb not suitable for revascularization is a difficult condition to manage. Thoracoscopic sympathectomy (TS) can be an effective procedure in this setting. Methods Our experience with 18 consecutive thoracoscopic sympathectomy (TS) procedures over a period of 7 years has been reviewed. Indications, operative technique, complications, and outcome of surgery are analyzed. Results We performed 18 TS procedures on 17 patients during this period. There were no deaths. One patient had intraoperative hemorrhage necessitating conversion to open thoracotomy. Mean postoperative hospital stay was 2.3 days. Follow-up ranged from 6 to 72 months. All patients demonstrated clinical benefit from the procedure. Conclusions Thoracoscopic sympathectomy is a useful option in patients with severely symptomatic hand and digital ischemia from occlusive small arterial disease like thromboangitis obliterans.     

Compensatory sweating after thoracoscopic sympathectomy for primary hyperhidrosis: Single institute experience

Objective: To investigate the incidence and impact of compensatory sweating (CS) after thoracoscopic sympathectomy (TS) for primary hyperhidrosis Methods: From June 1994 to February 2005, bilateral TS were performed for 50 patients with primary hyperhidrosis. A questionnaire to evaluate the outcome of hyperhidrosis, the severity of postoperative compensatory sweating, and its impact on social function was conducted via telephone interview in May 2005. A scoring system from zero to 100% was used to quantify the outcome of hyperhidrosis. The effect on social function and level of satisfaction with the outcome of TS was assessed. Results: Thirty‐six patients completed the questionnaire (overall response rate 72%). The mean age was 28 years. Thirty‐four patients experienced improvement in primary hyperhidrosis within the first week after TS and 35 patients experienced sustainable symptomatic improvement on long‐term follow up. Compensatory sweating occurred in 31 patients (86%). Nineteen of 26 patients (73%) who had been followed up for more than 1 year experienced no change in CS. Five other patients had worsening of CS over time. Only two patients reported either improvement or resolution of CS during the study period. Nevertheless, CS had no or a mild effect on the social function in the majority of patients (68%) and most patients (94%) were satisfied with the outcome of the operation. Conclusion: Thoracoscopic sympathectomy is an effective treatment for primary hyperhidrosis. Despite the frequent occurrence and persistence of compensatory sweating, thoracoscopic sympathectomy was considered by most patients to be a satisfactory treatment option for this disturbing condition.     

A new method of thoracoscopic sympathectomy in hyperhidrosis palmaris

Summary Although hyperhidrosis palmaris is a benign condition, it may cause considerable psychological, social, and occupational disturbances. There are many conservative measures used to treat hyperhidrosis, but surgical sympathectomy is the only permanent cure. Of the various surgical approaches to the upper thoracic sympathetic ganglia, one must select the approach that combines good functional results and a satisfactory cosmetic outcome with only minor complications. Twenty-one patients (10 men and 11 women) with hyperhidrosis palmaris underwent synchronous bilateral T2 sympathectomy between 1 October 1989 and 30 April 1990. These patients underwent a new method of thoracoscopic sympathectomy without preoperative pneumothorax. All were relieved of excessive sweating in their upper extremities immediately after the operation. In addition, the technique led to significant savings in operation and hospitalization time. We recommend thoracoscopic sympathectomy as the best approach for sympathectomy in cases of hyperhidrosis palmaris.     

Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach

Background  During recent years, thoracoscopic sympathectomy has been the standard treatment for hyperhidrosis. Different surgical techniques have been described without proving their advantages compared with other procedures. This study was designed to evaluate our modification of thoracoscopic sympathectomy and to compare the effectiveness between axillary and palmar hyperhidrosis. Methods  Ninety patients with axillary or palmar hyperhidrosis who underwent bilateral thoracoscopic sympathectomy with single-lumen ventilation with a dual 5-mm port approach were followed up for a median of 3.9 (range, 1–6) years. The clinical course and data during the hospitalization and consultation in our outpatient clinic were reviewed. The following parameters were evaluated: clinical improvement, satisfaction, changes in quality of life, and compensatory sweating and gustatory sweating. Results  The perioperative mortality was 0, and the morbidity was 6.5%. In 81% clinical improvement of sweating was noticed; 55% did not sweat at all. A total of 88% of patients were satisfied with the result of the operation. The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively. The result of sympathectomy in patients with palmar hyperhidrosis were significantly better concerning rate of satisfaction (p = 0.006) and improvement of symptoms (p = 0.027) compared with patients with axillary symptoms. Additionally it was found that the compensatory sweating had significantly impacted the satisfaction rating of the operation. Conclusion  Currently different effective surgical approaches for the treatment of hyperhidrosis with improvement rates of more than 80% are available. The quality of the intervention has to be evaluated by changes in quality of life and intensity of compensatory sweating. Thoracoscopic sympathectomy as performed in our institution offers results and complications comparable to previously published trials; however, because of single-lumen ventilation the management is much easier. Therefore, this technique offers an interesting option for the treatment of patients with palmar and axillary hyperhidrosis.     

Extensive or partial microsurgical sympathectomy of the arm by supraclavicular route for primary or secondary Raynaud symptoms

Surgery was performed in patients with Raynaud's disease (primary Raynaud symptoms) or with Raynaud symptoms as part of the cervical rib/scalenus-anticus syndrome (secondary Raynaud symptoms). In 13 arms with primary, and six with secondary Raynaud symptoms with trophic changes, the aim was extensive sympathectomy. Good results, without Horner's syndrome, were obtained with extensive postganglionic sympathectomy. When the grey ramus T1 could not be identified, T2 ganglionectomy and extirpation of the grey rami C7 and C8 were performed with the same result. Extirpation of the grey ramus C6 was not mandatory for a good result. Extirpation of unidentified T1 rami resulted in permanent Horner's syndrome in two of four patients. Cases of secondary Raynaud symptoms without trophic changes were divided into two equal groups, each of 18 arms. Combined neurovascular decompression and partial sympathectomy were performed in one group, and neurovascular decompression only in the other. Partial sympathectomy seemed to improve the results.