上胸段交感干切断术的微创外科解剖学

目的:探索胸交感干及其周围的显微解剖,为交感干切断术提供解剖学依据。方法:28例成人胸腔标本,在放大5×25倍手术显微镜下,对交感干及其周围组织进行逐层显微解剖、观察及测量。结果:星状神经节(颈胸神经节)及T2￣T5神经节的长径依次是(21.5±3.2)、(10.6±2.8)、(8.5±3.1)、(8.2±2.7)和(7.1±1.8)mm。T2￣T5神经节出现在相应肋间水平的发生率依次是92.7%、85.5%、40.0%、36.4%。旁路纤维只在T1或T2及T2或T3之间发现,出现率分别是69.1%、49.1%。结论:针对手汗症、头面多汗症治疗以及复合性局部疼痛综合症的交感干切断手术,只需切断节间束纤维及其旁路上传纤维即可,其余交感干的相关结构应尽量保护。

Minimal invasive anatomy of upper thoracic sympathectomy

Objective:To provide an optimal secure method for procedure of sympathectomy through observing microanatomy of the upper thoracic sympathetic trunk and its adjacent structures. Methods:28 adult cadavers with 55 sides sympathetic trunks were available, including 18 males and 10 females. The thoracic cavity and outlet was thoroughly exposed. Sympathetic ganglion and its affiliated ramus were observed and measured with the aid of microscopic instruments. Results:The incidence that T2~T5 ganglions located at the corresponding intercostal space was 92.7%, 85.5%, 40.0% and 36.4% respectively. Bypass fibers (Kuntz fibers) existed only between the T1T2 and T2T3 level, and the incidence was 69.1% and 49.1% respectively. Conclusions:The inter-ganglion ramus is the only structure that should be transected in the clinical sympathectomy for treatment of palm hyperhidrosis, craniofacial hyperhidrosis, facial blushing and complex regional pain syndrome (CRPS). Other structures correlating with the sympathetic trunk should be saved as far as possible.