手汗症患者胸交感神经旁路纤维超微结构的研究

Ultrastructural study of the nerve fibers bypass thoracic sympathetic chain in hyperhidrosis

目的 观察各型胸交感神经链旁路纤维组成,探讨胸交感神经链切断术（ETS）治疗手汗症是否需要切断旁路纤维.方法 对50例ETS治疗手汗症患者的胸交感神经旁路纤维进行腔镜下观察,并进一步行透射电镜对超微结构观察.结果 胸腔镜下观察胸2～4肋骨表面可见至少1种类型旁路纤维的概率为81％.透射电镜超微结构研究结果显示Ⅰ、Ⅱ、Ⅲ型旁路纤维有髓神经纤维占纤维总数百分比分别为66.44％、8.60％、8.88％;有髓神经髓鞘厚度分别为（1.07±0.15）、（0.62±0.15）、（0.59±0.12） μm.结论 Ⅰ型旁路纤维不属于交感神经系统,Ⅱ型及Ⅲ型均为无髓的节后神经纤维束,ETS治疗手汗症单纯切断交感神经链即可,没有必要切断旁路纤维.

Objective To observe the composition of the nerve fibers bypass thoracic sympathetic chain,and explore whether should these be interrupted during edoscopic sympathicotomy （ETS）.Methods Endoscopic observation was done on the bypass fibers of 100 laterals in 50 cases of palmar hyperhidrosis during ETS procedure.Then some fibers were observed under transmission electron microscope.Results The probability of presenting at least one type of bypass fibers on the surfaces of R2-T4 rib within unilateral chest cavity in the endoscopic observation was 81%.The percentage of myelinated type Ⅰ,type Ⅱ and type Ⅲ bypass fibers under transmission electronic microscopy was 66.44%,8.60%,and 8.88% respectively,and the average thickness of myelin sheath was （1.07 ± 0.15）,（0.62 ± 0.15） and （0.59 ± 0.12） μm respectively.Conclusion Type Ⅰ bypass fiber does not belong to the sympathetic nervous system,and type Ⅱ and type Ⅲ are unmyelinated sympathetic postganglionic fibers.It is enough to simply transect thoracic sympathetic chain in ETS procedure for treatment of palmar hyperhidrosis,and it＆#39;s not necessary to cut off the bypass fibers.