CAJ | 학술논문

目的探讨CT引导下经皮穿刺胸交感神经阻滞治疗手汗症的可行性.方法 2009年10月至2010年8月间在浙江省嘉兴市第一医院接受CT引导下经皮穿刺胸交感神经阻滞治疗的原发性手汗症患者23例,在CT引导下经胸3/4( T3/4)椎间隙穿刺,直至针尖解剖定位于第4肋骨小头上缘、第3椎体旁的壁胸膜外.注入含造影剂碘海醇的1％利多卡因3 ml,观察所注药液分布能覆盖胸交感神经链,患者手掌由冷湿变干暖,且无霍纳氏综合征,即可注入无水乙醇2.5ml.结果 CT 能精准引导穿刺针到达靶点,所注药液能覆盖相应节段胸交感神经链的位置.注药前后患者指脉血氧饱和度( SpO2)、指脉搏容积波波幅(A)及双手掌温(T)分别为(95.24±1.30)％比(99.06±0.24)％、(2.29±0.27)cm比(4.18±0.27)cm和(34.O±1.5)℃比(36.9±0.4)℃.注无水乙醇后19例患者手汗症一次治愈,4例患者经再次阻滞治愈,随访8～l8个月,2例有复发倾向.结论 CT引导下经皮穿刺胸交感神经链阻滞治疗手汗症是切实可行性的.
목적 탐토CT인도하경피천자흉교감신경조체치료수한증적가행성.방법 2009년10월지2010년8월간재절강성가흥시제일의원접수CT인도하경피천자흉교감신경조체치료적원발성수한증환자23례,재CT인도하경흉3/4( T3/4)추간극천자,직지침첨해부정위우제4륵골소두상연、제3추체방적벽흉막외.주입함조영제전해순적1％리다잡인3 ml,관찰소주약액분포능복개흉교감신경련,환자수장유랭습변간난,차무곽납씨종합정,즉가주입무수을순2.5ml.결과 CT 능정준인도천자침도체파점,소주약액능복개상응절단흉교감신경련적위치.주약전후환자지맥혈양포화도( SpO2)、지맥박용적파파폭(A)급쌍수장온(T)분별위(95.24±1.30)％비(99.06±0.24)％、(2.29±0.27)cm비(4.18±0.27)cm화(34.O±1.5)℃비(36.9±0.4)℃.주무수을순후19례환자수한증일차치유,4례환자경재차조체치유,수방8～l8개월,2례유복발경향.결론 CT인도하경피천자흉교감신경련조체치료수한증시절실가행성적.
Objective To explore the therapeutic feasibility of percutaneous puncture and neurolytic thoracic sympathetic nerve block under the guidance of computed tomograph (CT).Methods From September 2009 to August 2010,23 cases with primary palmar hyperhidrosis underwent percutaneous puncture and neurolytic thoracic sympathetic nerve block at our hospital.The puncture of thoracic sympathetic nerve was guided by CT through the gap of T3-4.The screen showed the direction of needle and the location of needle tip at the upper joint of costal head beside T3 body and outside of costal pleura.A mixed injection of 1％ lidocaine and 30％ iohexol was administered.On CT,lidocaine was found to cover the area where the thoracic sympathetic nerve was located.And after several minutes,the patient's palms turned warm and dry from cool and wet without the onset of Homer's syndrome.Then 2.5 ml of absolute alcohol was injected to block the thoracic sympathetic nerve.Results CT could guide the needle to the right position.And the injectate spreaded to the site of thoracic sympathetic nerve.At 5 min after anesthetic injection,the palmar temperature raised an average of 2.86 ℃ and the amplitude of pulse rose over 55％.Palmar hyperhidrosis was cured in 19 patients by one attempt and 4 patients required a second block with absolute alcohol.No complication occurred and there were 2 patients with tendency of recurrence during a follow-up period of 8 - 18 months.Conclusion The CT-guided therapy of percutaneous puncture and chemical neurolysis of thoracic sympathetic nerve block is both feasible and efficacious for palmar hyperhidrosis.