经脐内镜下胸交感神经节切除术

The investigation of endoscopic transumbilical thoracic sympathectomy in experimental models

目的探讨经脐内镜下胸交感神经切除术的安全性和可行性。方法4只家猪常规麻醉下经脐放入特制超长腹腔镜戳卡（troear），建立气腹。胃镜沿戳卡进入腹腔后使用针状刀分别在左右膈肌穹顶做一切口，将胃镜送入胸腔。单肺通气下使用热活检钳行左右T3交感神经节切除术，膈肌切口自然旷置。手术完成后将其处死解剖。结果4例手术均成功完成，手术平均（81．7±15．4）min，术中无明显出血及周围脏器损伤。术后无气胸发生。解剖证实所有猪的左右13交感神经节均被切除。结论经脐内镜下胸部交感神经节切除术安全、可行，美容效果好。

Objective To evaluate the safety and feasibility of endoscopic transumbilical thoracic sympathectomy. Methods The technique was performed in 4 swine models. Under general anesthesia, a newly developed long abdominal tro- car （60 cm in lengths） was placed through the umbilicus, which was also used to establish pneumoperitoneum. After insertion of gastroscope through this trocar, two small incisions of diagrams were created by needle-knife, through which the gastroscope was sent into the thoracic cavity to ablate the T3 ganglia by Hot biopsy forceps under One-lung ventilation. The animals were killed at the completion of the procedure. Results This procedure was completed in four pigs. The sympathetic chain was suc- cessfully ablated in all swine, as confirmed by gross surgical pathology and histology, the mean operative time was（ 81.7 ± 15.4） minutes. There was no major bleeding. All bilateral T3 sympathetic chains were successfully ablated in the 4 swines as confirmed by gross surgical pathology and histology. There was no severe bleeding and damage to peripheral organs during the operation in any of the cases, and no prominent pneumothorax was revealed by postoperative chest X-ray radiography. Conclu- sion Endoscopic transumbilical thoracic sympathectomy is safe, feasible and effective with good cosmetic result.