化学性胸交感神经节切除术治疗雷诺综合征方法的探讨

Researching methods of treating Raynaud’s syndrome by chemical thoracic sympathectomy

目的探讨并比较X线透视与CT定位下化学性胸交感神经节切除术(CTS)治疗雷诺综合征的安全性及有效性。方法 2001年3月～2008年12月本院134例(259条上肢)雷诺综合征患者按照不同的定位方法分为两组:111例(213条上肢)患者在X线定位下经皮穿刺至T2或T3交感神经节处注射5%酚实施CTS(住院组);23例(46条上肢)在CT定位下经皮穿刺至T2或T3交感神经节处注射5%酚实施CTS(门诊组)。结果住院组及门诊组的治疗有效率分别为87.8%(187/213)、82.6%(38/46),两组比较无显著差异(P>0.05)。并发症比较:住院组及门诊组气胸发生率分别为11.3%(24/213)、0(0/46),两组比较有显著差异(P<0.05);而腋下痛肢体数(12条、5条)、窦性心动过缓(1例、0例)及Horner征(5例/条、0例)在两组中比较均无显著差异。结论 CT定位下CTS的操作准确,可以避免气胸的发生,其疗效与X线透视定位方法相同,创伤极小,可在门诊治疗,是目前雷诺综合征保守治疗无效时较合理的治疗选择。

Objective Doing contrastive research of treating Raynaud’s syndrome by chemical thoracic sympathectomy(CTS) guided between by X ray and CT.Methods From Mar.2001 to Dec.2008,134 cases (259 limbs) of Raynaud’s syndrome were divided into two groups according to different guiding method.Inpatient group treated by CTS (from Mar.2001 to Sep.2007) was guided by X ray,a needle was punctured through back skin to the second or the third thoracic sympathetic ganglion beside the thoracic vertebrae and 3ml of 5% phenol was injected.Outpatient group treated by CTS (from Oct.2007 to Dec.2008) was guided by CT,other manipu- lations were the same with inpatient group.Results The efficient rate of inpatient group (87.8%) was similar to outpatient group (82.6%) (χ2=0.048,P>0.05).Pneumothorax morbidity of inpatient group was 11.3% and that of outpatient was 0 (χ2=5.712,P<0.05).Axilla pain of inpatient group was occured in 12 limbs and that of outpatient was in 5 limbs(P>0.05).Bradycardia of inpatient group was 1 case and that of outpatient was 0(P>0.05).Horner’s syndrome of inpatient group was 5 cases (unilateral) and that of outpatient was 0(P>0.05).Conclusions CTS guided by CT is exact,mini-invasive,and can avoid pneumothorax.It’s efficacy is similar to that by X ray and can be operated on outpatient.It is a good selection on treating Raynaud’s syndrome today when conservative therapy is noneffective.