upper thoracic sympathectomy

The sympathetic nerve fibers of the upper limbs are mainly from the astrocytic ganglia, and only a small part of the sympathetic nerve fibers from the chest 2 to 3, so the upper thoracic sympathectomy is mainly to cut the preganglionic fibers of the 2nd and 3rd thoracic sympathetic nerves. As for the preservation of the 2nd and 3rd sympathetic ganglia, only the traffic branch is cut off, and the sympathetic trunk is cut off at the distal end of the third thoracic sympathetic ganglia. These two methods are related to the sympathetic innervation of the upper limbs, which belong to the category of preganglionic fiber cutting. It is better than astronomical ganglion resection. Treating diseases: Raynaud's disease Indication Upper thoracic sympathectomy is available for: 1. Upper limbs such as Raynaud's disease, burning neuralgia and hyperhidrosis. 2. After the stagnation of the astrosteal ganglion, the symptoms are temporarily relieved or disappeared temporarily. Contraindications The above-mentioned upper limb sympathetic nervous system disease has mild clinical symptoms, or is delayed by the astrogang ganglion, and the clinical symptoms are not improved. Preoperative preparation 1. Prepare the rib removal device. 2. Prepare closed thoracic drainage for pleural rupture. Surgical procedure Skin incision Centered on the third rib, 3 cm from the midline, a longitudinal oblique or a oblique oblique incision with the trapezius muscle, about 8 cm long. Muscle incision Muscle fibers such as the slanting square muscle, the rhomboid muscle, and the sacral spine muscle travel in the direction of the muscle fibers. 3. Accurately determine the 2nd and 3rd ribs After cutting the deep fascia and paravertebral muscles, use the fingers to count the third rib from top to bottom, and cut the third rib periosteum near the third thoracic transverse process. The pleura should be protected when the periosteum is removed. A section of ribs 4 to 5 cm was removed, and the transverse process and rib head were removed inward. Protect the pleura with saline gauze and find the 2nd and 3rd intercostal nerves. 4. Reveal the sympathetic ganglia With the 2nd and 3rd intercostal nerves, the longitudinal sympathetic trunk can be seen on the pleural surface near the lateral edge of the vertebral body. At the intersection with the 2nd and 3rd intercostal nerves, the 2nd and 3rd thoracic sympathetic nerves are found. Festival and its traffic branch. Free the 2nd and 3rd thoracic sympathetic ganglia, and cut off the sympathetic trunk and the traffic branches of the 2nd and 3rd ganglia at the lower end of the 3rd sympathetic section. The free sympathetic ganglia are wrapped in fascia and buried in nearby muscles. The second and third thoracic sympathetic nerves can also be removed. 5. Stitching After complete hemostasis, a drainage strip was placed outside the pleura to layer the layers of muscle, fascia, subcutaneous tissue and skin. complication Pneumothorax and hemothorax: thoracic puncture, closed thoracic drainage if necessary.

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