SYMPATHECTOMY [lat. (systema nervorum) of sympathicum sympathetic nervous system + Greek ektome excision, removal; synonym simpatikotomiya] — surgery — a resection of a sympathetic nervous trunk (its nodes or branches).
Distinguish total S. — removal of a boundary trunk with a chain of sympathetic nodes, partial — removal of a sympathetic node, trunkular — a resection of a sympathetic trunk, periarterial — removal of a carotid glome, outside cover or adventitia of arteries, with the sympathetic fibers passing in it, a splanchnicectomy — a resection of celiac nerves. Besides, allocate preganglionic and postganglionic S. Razlichayut also unilateral and bilateral S., single-step and step-by-step to Page.
The purpose C. — interruption patol. the centripetal impulses creating the resistant centers of excitement in c. N of page, and also disturbance of a flow of the centrifugal pathological impulses capable to cause a vasculomotor spasm, circulatory disturbances, humoral and trophic disturbances in the center of defeat. The Page in these conditions is caused a vazodilatation, the peripheral spasm is removed, collateral circulation in desimpatizirovanny area improves. Under the influence of S. microcirculation improves, healing of trophic ulcers accelerates, sites of a necrosis are limited, decrease Foley, inflammatory process abates-.
The page belongs to palliative methods of treatment. It is made at obliterating defeats of vessels of extremities, a Raynaud's disease, coronary heart disease, an idiopathic hypertensia, disturbances of cerebral circulation. Pages apply also at pain syndromes, kauzalgiya, tabic crises, simpatalgiya, at pancreatitis, bronchial asthma and a scleroderma. S. A. Rusanov with success used lumbar S. on the party of defeat for fight against the threatening ischemic gangrene of the lower extremity after bandaging of a wounded main artery. In these cases S. is reasonable if but-vokaiiovaya blockade lumbar gangliyev gave rather clear, but short-term effect.
Contraindications to S. are serious condition of the patient, cardiovascular and endocrine insufficiency, a pulmonary tuberculosis and pleurae (chest S.), inflammatory diseases of bodies of a chest and abdominal cavity. A relative contraindication to chest S. — kifoskoliotichesky deformation of a backbone with a costal hump.
A preparation for surgery and anesthesia same, as at operative measures on a neck, chest and belly cavities. At cervical S. local anesthesia can be applied (see. Anesthesia local ), chest and belly S. is carried out under anesthetic (see. Inhalation anesthesia ).
For removal of an upper cervical sympathetic node (C1) use zachelyustny access (see. Gangliectomy , Ramicotomy ). After an exposure of a neurovascular bunch of a neck open a prevertebral fascia and carry out a ramicotomy, a gangliectomy. In need of more radical desimpati-zation the ganliektomiya is combined with denudation (see) carotid arteries and resection of a carotid glome. The average cervical sympathetic node is found at the level of a thyroid gland. The lower cervical sympathetic or star-shaped node is deleted with front or back access. At front access make cross supraclavicular or a slit respectively grudino - a clavicular and mastoidal muscle. Bare a neurovascular bunch of a neck, a subclavial artery. In the depth of a wound behind vessels define a star-shaped node. Having opened a plevrokostalny sheaf, it is deleted.
The page in chest department can be carried out ekstraplevralno and transplevralno, and also at a torakoskopiya (endoscopic S.). Ekstraplevralno chest S. is carried out a section behind on the centerline or paravertebralno. After a resection of cross shoots and one-two adjacent edges bare a parietal pleura and resect nodes of a sympathetic trunk, to-rye are located near intercostal nerves. Transplevralno S. is made a section on the IV mezhreberye or a side axillary section with the subsequent opening of a pleura over a sympathetic trunk. Endoscopic chest S. is carried out at torakoskopiya (see) through the IV mezhreberye on the average axillary line. After introduction of the thoracoscope the manipulator take away an upper lung lobe from top to bottom and medially. Elektrokauts-rom cut a pleura and an intrathoracic fascia. The sympathetic trunk is allocated with the manipulator, cross connecting branches and excise nodes.
Lumbar S. is made transabdominal and extra peritoneal accesses. At transabdominal access open an abdominal cavity (see. Laparotomy ). Cut a parietal peritoneum according to an aorta or the lower vena cava on the party assumed by Page. At a single-step gangliectomy and a resection of an upper hypogastric texture the section is prolonged from top to bottom also by knutr. After a bilateral gangliectomy resect an upper hypogastric texture on bifurcation of an aorta. At extra peritoneal access use a section of a knaruzha from a direct muscle of a stomach or from the XI edge to an ileal crest.
In the postoperative period appoint antiinflammatory and anesthetics, hold a complex of the events directed to prevention of pneumonia, paresis of intestines, disturbances of cordial activity.
At S.'s carrying out various complications are possible, it is preferential at the expense of operational errors. After cervical S. paresis of muscles of a neck, disturbance of phonation sometimes develop. During removal of a star-shaped node disorders of breath and a reflex cardiac standstill, damage chest limf, a channel are described. Chest S. can be complicated by pleurisy, a hemothorax, pneumonia. At endoscopic chest S. injuries of easy, intercostal arteries, a hemothorax, pleurisy are described. At lumbar S. damages of ureters, formation of a retroperitoneal hematoma are possible, paresis of intestines quite often develops.
The immediate results of S., according to various data, are characterized expressed to lay down. effect in 50 — 80% of cases. The long-term results are not always positive. The best outcomes of S. note at functional changes; at organic lesions, in cases of the expressed trophic frustration, S.'s effect is much weaker.
Bibliography: Ivanov I. A. Adrenal - and a sympathectomy at obliterating diseases of vessels of the lower extremities, Owls. medical, No. 1, page 72, 1979, bibliogr.; Kokhan E. P., Zobnin I. V. and M and r about N e N to about A. A. The long-term results of a lumbar sympathectomy at patients with obliterating atherosclerosis of the lower extremities, Surgery, No. 1, page 59, 1979; Mikhayloven and y V. S. Surgical interventions on the autonomic nervous system at unrestrained pains in pelvic area, Vopr. neyrokhir., L ‘-3, page 35, 1967; Nesterov S. S., 0 in the h and N of II and to about in V. A. and M and z Ilii about in K. N. A lumbar sympathectomy at treatment of obliterating diseases of arteries of the lower extremities, Surgery, Li 2, page 23, 1978; Rusanov S.A. Recognition and treatment of gunshot wounds of blood vessels of extremities, M., 1954; Fokin A. A., Shapiro M. Ya. and In e r about in e c to and y JI. P. Endoscopic chest sympathectomy, Gr\tdn. hir., No. 4, page 77, 1976; M a t-t a's s i R., Miele F. D'Ange-1 o F. Thoracic sympathectomy, J. cardiovasc. Surg. (Torino), v. 22, p. 336, 1981; S e b e s t e n y M. u. a. Spater-gebnisse der thorakalen Sympathektomie b ei verschiedenen Krankheitsbildern, Acta chir. Acad. Sci. hung., Bd 19, S. 69, 1978.
V. S. Mikhaylovsky.