GANGLIECTOMY

From Big Medical Encyclopedia

GANGLIECTOMY (Latin ganglion nerve knot + ektome removal, excision; synonym: sympathetic gangliectomies, ganglionic sympathectomy) — removal of one or several nodes of a sympathetic trunk with destruction of their connecting branches in cervical, chest or lumbar departments on one or both sides of a body. The purpose of operation — interruption of a sympathetic innervation of the respective area.

Distinguish G. preganglionic and postganglionic. So, during the crossing of a sympathetic trunk at any level in a neck all preganglionic fibers going from the I chest node to an upper cervical node therefore there is a temporary reddening of the corresponding half of the face, an anhidrosis and Bernard's syndrome — Horner (see are interrupted. Bernard-Horner syndrome ) on the party of operation. However this operation influences the postganglionic fibers going from an upper cervical node to upper cervical nerves to wandering, hypoglossal and to other nerves of this area, to outside and internal sleepy textures a little. Removal of an upper cervical node is postganglionic G.

Preganglionarna G. for upper extremities there will be a removal of the II chest node or II and III together since through these nodes there passes the most part of preganglionic fibers. Removal of the called nodes breaks communication of a sympathetic innervation of an upper extremity with the vegetative centers, but the innervation of vessels significantly is not broken since the main source of postganglionic fibers for vessels and sweat glands of an upper extremity, the person and an eye is the star-shaped node. Therefore removal of a star-shaped node is designated as postganglionic G. for an upper extremity, the person and an eye.

Preganglionic G. for the lower extremity is removal of the II—III lumbar sympathetic nodes, and postganglionic — the III—IV. Owing to extreme variability of a structure of lumbar nodes and connecting branches orientation in their sequence number is always approximate. Postganglionic G., unlike preganglionic, is followed by sensitization of blood vessels to vasoconstrictive effect of the adrenaline circulating in blood that can lead to a vasospasm after operation. Removal of a star-shaped node is followed, besides, by a resistant syndrome of Bernard — Horner.

Indications

Sympathetic G. is effective hl. obr. at treatment obliterating, diseases of arteries of extremities, a local pathological hyperhidrosis and kauzalgiya. At obliterating diseases of arteries of extremities it is necessary to consider that the medical effect of operation is caused mainly by vasodilatation of precapillary network in the presence of the developed collaterals. If collateral circulation is not enough and necrotic changes quickly accrue, then G. is not shown since expansion of precapillary network in such cases is followed, as a rule, by further catastrophic deterioration in food of fabrics. Therefore during the definition of indications the main attention should be paid to a condition of a hemodynamics and collateral circulation. In system of a complex research of patients the method of segmented is of great importance reografiya (see) and diagnostic novocainic blockade of the corresponding nodes of a boundary trunk. At a local pathological hyperhidrosis removal of the corresponding nodes, napr, upper chest at an axillary hyperhidrosis, is followed by the permanent termination of sweating on all upper extremity, in axillary area and on a face. However sweating on a trunk can amplify. At G.'s kauzalgiya of the corresponding nodes is an effective method of treatment. All phenomena of a kauzalgiya can disappear after intervention.

Technology of operation

the Scheme of some options of a structure nervous gangliyev a boundary sympathetic trunk in lumbar department (the specified changes should be considered at a lumbar gangliectomy). Nervous a ganglion and the branches connecting them are designated in black color. The Roman figures — the corresponding lumbar vertebrae.

At G. the intubation anesthesia with muscle relaxants is recommended. It is better to make removal of an upper cervical node (operation rare) from rather long section on a first line grudino - a clavicular and mastoidal muscle. Verkhnegrudny preganglionic G. can be made as from back extra pleural access with a resection only of II or II and III edges, and from transpleural on the III mezhreberye in axillary area without resection of edges. Very important at operation to cross additional branches to a brachial plexus from II and III nodes. The most widespread access for lumbar G. Yavlyaetsya front and side Extra peritoneal with division of muscles according to the course of their fibers; operation can be executed also from back retroperitoneal and transabdominal accesses. It is necessary to consider big variability of a structure of nodes of lumbar department of a sympathetic trunk (fig.) and to delete sympathetic a ganglion, located on the anterolateral surface of lumbar vertebras, possibly above.

A frequent complication of verkhnegrudny G. from back extra-pleural access is wound of a pleura and pheumothorax. After lumbar G. sometimes there are pains on the course of podvzdoshnopakhovy, iliohypogastric or femoral nerves that, most likely, is connected with a stupid injury of these nerves hooks at cultivation of edges of a wound. Wound of an aorta at the left or the lower vena cava belongs to rare, but dangerous complications of lumbar G. on the right.

The insufficient effect or a total failure of G. are most often connected with wrong definition of indications to operation, the insufficient account during operation of big individual variability of a structure of nodes and connecting branches. A lethality at G. minimum.

See also Sympathectomy .


Bibliography: Berezin V. N. About the mechanism of action of a lumbar sympathectomy, Vestn, hir., t. 97, No. 9, page 21, 1966; Grigorovich K. A. About the reasons of insufficient effect of a lumbar sympathectomy at obliterating diseases of arteries of the lower extremities, in the same place, page 14; it, About diagnosis of a kauzalgiya, in the same place, t. 101, No. 7, lake 13, 1968; Grinstein A. M. and P about p about in and N. A. Vegetative syndromes, M., 1971, bibliogr.; Polenov A. L. and Bondarchuk of A. V. Hirurgiya of the autonomic nervous system, page 73, L., 1947; And 1 1 e n E. V., Barker N. W. a. Hines E. A. Peripheral vascular diseases, Philadelphia — L., 1962; Complications in surgery and their management, ed, by C. P. Artz a. J. D. Hardy, Philadelphia — L., 1961.

K. A. Grigorovich.

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