CAJ | 학술논문

目的观察各型胸交感神经链旁路纤维组成,探讨胸交感神经链切断术(ETS)治疗手汗症是否需要切断旁路纤维.方法对50例ETS治疗手汗症患者的胸交感神经旁路纤维进行腔镜下观察,并进一步行透射电镜对超微结构观察.结果胸腔镜下观察胸2～4肋骨表面可见至少1种类型旁路纤维的概率为81％.透射电镜超微结构研究结果显示Ⅰ、Ⅱ、Ⅲ型旁路纤维有髓神经纤维占纤维总数百分比分别为66.44％、8.60％、8.88％;有髓神经髓鞘厚度分别为(1.07±0.15)、(0.62±0.15)、(0.59±0.12) μm.结论 Ⅰ型旁路纤维不属于交感神经系统,Ⅱ型及Ⅲ型均为无髓的节后神经纤维束,ETS治疗手汗症单纯切断交感神经链即可,没有必要切断旁路纤维.
목적 관찰각형흉교감신경련방로섬유조성,탐토흉교감신경련절단술(ETS)치료수한증시부수요절단방로섬유.방법 대50례ETS치료수한증환자적흉교감신경방로섬유진행강경하관찰,병진일보행투사전경대초미결구관찰.결과 흉강경하관찰흉2～4륵골표면가견지소1충류형방로섬유적개솔위81％.투사전경초미결구연구결과현시Ⅰ、Ⅱ、Ⅲ형방로섬유유수신경섬유점섬유총수백분비분별위66.44％、8.60％、8.88％;유수신경수초후도분별위(1.07±0.15)、(0.62±0.15)、(0.59±0.12) μm.결론 Ⅰ형방로섬유불속우교감신경계통,Ⅱ형급Ⅲ형균위무수적절후신경섬유속,ETS치료수한증단순절단교감신경련즉가,몰유필요절단방로섬유.
Objective To observe the composition of the nerve fibers bypass thoracic sympathetic chain,and explore whether should these be interrupted during edoscopic sympathicotomy (ETS).Methods Endoscopic observation was done on the bypass fibers of 100 laterals in 50 cases of palmar hyperhidrosis during ETS procedure.Then some fibers were observed under transmission electron microscope.Results The probability of presenting at least one type of bypass fibers on the surfaces of R2-T4 rib within unilateral chest cavity in the endoscopic observation was 81％.The percentage of myelinated type Ⅰ,type Ⅱ and type Ⅲ bypass fibers under transmission electronic microscopy was 66.44％,8.60％,and 8.88％ respectively,and the average thickness of myelin sheath was (1.07 ± 0.15),(0.62 ± 0.15) and (0.59 ± 0.12) μm respectively.Conclusion Type Ⅰ bypass fiber does not belong to the sympathetic nervous system,and type Ⅱ and type Ⅲ are unmyelinated sympathetic postganglionic fibers.It is enough to simply transect thoracic sympathetic chain in ETS procedure for treatment of palmar hyperhidrosis,and it's not necessary to cut off the bypass fibers.