Thoracoscopic Sympathectomy's Curative Effect In The Treatment Of Upper Limb Ischemic Diseases

Objective:To review the data that we performed video-assisted thoracoscopic sympathectomies(VATS) in patients with upper limb ischemic diseases, aim at demonstrating VATS's curative effect in the treatment of upper limb ischemic diseases.Data and Methods:We collected data from vascular surgery department since January 2010, there are 24 patients who had experienced thoracoscopic sympathectomy with the use of video-assisted thoracoscopy for the treatment of upper limb ischemic diseases,including male 16, female 8, with an average age of 46.32 years old. The condition is unilateral in eight patients and bilateral in 16.Their main symptom is coldness, pain,numbness, cold black skin necrosis in the upper limbs.Operation method: thoracoscopic sympathectomy with the use of video-assisted thoracoscopy(T3-T4).Position: take high clinostatism, double arm abduced, divided into single span and double hole method.Results:Follow-up range from 12 to 62 months,with a mean of 43.7±16.3months.40 ischemic limbs' postoperative and 3,6,9,12 months of follow-up pain score, and they are all compared with their preoperative pain scores by using T test group were 1.80 ± 1.94(t =6.334); 1.43 ± 1.53(t = 7.285); 1.03 ± 1.53(t = 7.613); 0.45 ± 1.24(t = 8.083); 0.60 ±1.45(t = 8.115),result in all P <0.01, Suggesting that short-term postoperative limb pain had been significantly improved.Besides,there are 16 limbs had completed a full60-month follow-up period, postoperative and postoperative follow-up with patients before each statistical test results,and we also get all the P <0.01, suggesting that the results show this procedure is conducive to long-term improvement in finger pain.Preoperative 180 fingers' temperature was 27.40±2.46(?), after surgery and 3,6, 9,12 months of follow-up finger temperature were 29.01±2.95, 28.57± 2.56,28.48±2.48, 28.37±2.41, 28.32±2.39(?);and compared with preoperative fingertemperature respectively,resulting in P <0.01,it turned out that short-term postoperative limb cold relief obviously.40 limb radial artery preoperative and postoperative ABI values respectively was 0.91±0.15 and 0.93±0.10(P > 0.05);Ulnar artery was 0.92±0.14 and 0.94 ±0.10(P > 0.05).PPG waveform change result: 14 no change, 12 slightly elevated;4 moderately elevated;10 increased significantly.Incidence of postoperative complications: 1 cases of chest distress, anhelation merger pleural effusion, 1 case of shock with the left side of the hydropneumothorax.The long-term complications: 1 case of compensatory sweating increases in the anterior part of chest;1 case appeared on the right side of head and neck and right arm without sweat, yet the chest and back's compensatory sweating increased obviously, double palm red;1 case describe that the chest incision around also have a dull pain occasionally.Four patients postoperative recurrence.Conclusions:Vedio-assisted thoracoscopic sympathectomy's clinical application(T3-4) in the treatment of upper limb ischemia diseases,its minimally invasive, sffety,efficacy,with a low rate of complications is feasible.