ABSTRACT
Objective To summarize the experience of fluoroscopy-guided chemical thoracic sympathectomy(CTS) for the treatment of Raynaud's phenomenon.Methods A series of 73 cases of Raynaud's phenomenon(141 upper limbs) treated with CTS from March 2001 to September 2005 in this hospital was chronologically divided into two groups: the Group A between March 2001 and December 2002 and the Group B between January 2003 and September 2005.In the Group A,under the guidance of X-ray fluoroscopy,a needle was punctured through the back skin to the second or the third thoracic sympathetic ganglion beside the thoracic vertebrae and 2 ml of 5% phenol was injected.In the Group B,when the needlepoint reached the rear edge of target thoracic vertebra,2~3 ml of anesthetic was injected.Then the needle was advanced sequentially untill the needlepoint reached the sympathetic ganglion.Other manipulation was the same with the Group A. Results The incidence of pneumothorax in the Group A(28.4%,19/67) exceeded greatly that in the Group B(4.1%,3/74)(?~2=15.773,P=0.000).The effective rate in the Group A(77.6%,52/67) was much lower than that in the Group B(97.3%,72/74)(?~2=12.851,P=0.000).Between the two groups,differences of the incidence of axilla pain(Group A,2 limbs;Group B,5 limbs)(?~2=0.411,P=0.521),bradycardia(Group A,1 case;Group B,nil)(?~2=0.002,P=0.967),and Horner's syndrome(Group A,1 case;Group B,1 case)(?~2=0.000,P=1.000) were not statistically significant.Conclusions Pneumothorax is a common complication of chemical thoracic sympathectomy.Improvement of procedure can reduce the incidence of pneumothorax and increase the effective rate.
ABSTRACT
Objective To explore the effectiveness and safety of CT-guided chemical thoracic sympathectomy(CTS) for Raynaud′s phenomenon in the upper limbs.Methods Ten patients with Raynaud′s phenomenon in 20 limbs were enrolled in this study.Among the patients,4 were recurrent cases,who had undergone X-ray-guided CTS.Under CT guidance,a needle was punctured through the back skin to the second or third thoracic sympathetic ganglion beside the thoracic vertebrae,and then 3 ml of 5% phenol was injected into each located point.Results After the treatment,10 limbs achieved excellent outcomes,3 were good,4 were improved,and 3 were non-effective.The totally effective rate was 85.0%(17/20).The effective rate was 92.9%(13/14) in the limbs with primary Raynaud′s phenomenon,66.7%(4/6) in those with secondary Raynaud′s phenomenon,and 75.0%(6/8) for the recurrent cases.No patient developed pneumothorax. Conclusions CT-guided CTS is a minimally invasive surgery for Raynaud′s phenomenon in upper limbs with a high effective rate.The procedures can be used to treat recurrent cases.
ABSTRACT
Objective To investigate the therapeatic effects of chemical thoracic sympathectomy (CTS) for Raynaud disease. Methods A niddle was injected into the first or second thoraic vertebra from back. A X-ray examination was performed to definite the position of the niddle tip. One millilitre of urographine was injected to determine if it was infused into thoracic cavity. If not, 2 ml of 5% phenol was injected and the niddle was removed. Results Within 10 minutes both pairs of the hands of the two patients with Raynaud's disease turned into flushing and warm from pallor and cool after CTS. Ice-water test changed to negative. Conclusions CTS is of simple, microinvasive and low cost procedure for Raynaud's disease.