胸交感神经调制治疗头汗症时霍纳综合征的效果分析

Prevention and treatment of Horner syndrome in treatment of head and face hyperhidrosis by thoracic sympathetic nerve modulation

目的总结CT引导下胸交感神经调制治疗头面部多汗症时霍纳综合征的预防与治疗措施，以减少该并发症的发生。方法回顾性分析嘉兴市第一医院2010年1月至2016年12月间116例cT引导下胸交感神经调制治疗头汗症时霍纳综合征的发生原因及处理经过，总结相应的预防和救治措施。结果在cT定位引导下，116例患者均按设定的穿刺路径成功穿刺至预定靶点（两侧R3肋骨小头上方），注射局麻药加造影剂后，CT扫描显示有39侧药液沿胸膜外上行平齐（26侧）或超过（13侧）R1肋骨小头上方。注射无水乙醇后，再次CT扫描观察，有43侧药液沿胸膜外上行平齐（24侧）或超过（19侧）R1肋骨小头上方，术毕出现霍纳综合征22侧，其中19侧立即给予同侧星状神经节处注入生理盐水5ml，2h内霍纳综合征完全消失。3例未做处理者，霍纳综合征持续3个月-2年方恢复。结论cT引导下胸交感神经调制治疗头面部多汗症时霍纳综合征的发生率较高，立即向该侧星状神经节处注入生理盐水5ml可消除这一常见并发症。

Objective By summarize the Prevention and Treatment of Homer Syndrome of CT- guided thoracic sympathetic nerve modulation in the treatment of head and face Hyperhidrosis, reduce the occurrence of the complications. Methods A retrospective analysis was made on 116 patients of CT-guided thoracic sympathetic nerve modulation in the treatment of head and face Hyperhidrosis in The First Hospital of Jinxing from January 2010 to December 2016. Analysis the reasons of Homer syndrome and external management to sum up the corresponding prevention and treatment measures. Results Under the guidance of CT positioning, 116 patients were successfully punctured to the intended target （both sides of the R3 above the rib head ） , after injection of local anesthetic plus contrast agent, CT scan showed there are 39 sides of the liquid parallel to the outside of pleural （26 sides） or over （13 sides） RI above the rib head. CT scan again after the injection of anhydrous alcohol, there are 43 sides of the liquid parallel to the outside of pleural （24 sides） or over （19 sides） Rlabove the rib head. After the operation, 22 sides appeared Homer syndrome, 19 of which immediately give physiological saline 5 ml into the ipsilateral Satellite ganglion. Within 2 hours Homer＇s syndrome completely disappeared, while 3 cases were not treated, Homer syndrome lasts for 3 months to 2 years. Conclusion The incidence of Homer syndrome relatively high during the CT-guided thoracic sympathetic nerve modulation to treatment of head and face Hyperhidrosis. Injecting 5 ml physiological saline into the ipsilateral Satellite ganglion immediately can completely eliminate this common complications.