종경동경을 이용한 요부 교감신경 절제술

Mediastinoscopic Lumbar Sympathectomy

  • 김동원 (인제대학교 상계백병원 흉부외과)
  • Kim Dong Won (Department of Thoracic and Cardiovascular Surgery, Inje University, Sanggyepaik Hospital)
  • 발행 : 2005.03.01

초록

요부 교감 신경 절제술은 족부 다한증, 하지 혈관 질환 및 신경계 질환의 치료를 목적으로 시행되는 수술로 흉부교감 신경 절제술에 비해 수술 빈도는 많이 떨어지나, 최근의 수술 경향인 최소 침습 수술의 발달과 복강경을 이용한 요부 교감 신경 절제술이 소개되면서 관심이 증가되었다 대상 및 방법: 2003년 7월부터 2004년 12월까지 18명의 환자에서 종격동경을 이용한 요부 교감 신경 절제술을 시행하였는데 환자의 남녀비는 12:6으로 남자가 많았고 평균 연령은 24.3세였으며, 수술 부위는 12명의 족부 다한증 환자에서는 양측을 수술하였고 나머지 6명의 환자에서는 좌측 4예, 우측 2예의 수술을 시행하여 총 30예의 요부 교감 신경 절제술을 시행하였다. 결과: 평균 수술 시간은 37.2$\pm$12.5 분이었으며 수술 후 평균 재원일은 3.1$\pm$2.2일이였다. 결론: 종격동경을 이용한 요부 교감 신경 절제술은 간단하고 효과적인 수술 방법으로, 미용적인 측면과 수술 후 동통의 감소 및 수술 후 재원 기간의 단축 등의 장점이 있는 수술이라고 생각되며, 향후 더 많은 수의 환자에서 결과를 분석하여 더 나은 결과를 가져올 수 있다고 예상된다.

Lumbar Sympathectomy is a surgery for plantar hyperhidrosis, vascular and other reflex sympathetic diseases and has a various indications and physiologic effects. However it is not performed actively compared to thoracic sympathectomy because of its invasiveness. Therefore, we tried to perform lumbar sympathectomy using mediastinoscopy with small incision and introduce this new surgical technique. Material and Method: From July 2003 to December 2004, 18 patients undewent lumbar sympathectomy with mediastinoscopy at Inje University Sanggye Paik Hospital. There were 12 males and 6 females whose mean age was 24.3$\pm$8.2 years ranging from 18 to 67 30 cases of lumbar sympathectomy was performed with mediastinoscopy of which 24 cases were for plantar hyperhidrosis and 6 cases for other diseases. Result: Mean operation time was 37.2$\pm$12.5 minutes and mean post operation hospital stay was 3.1$\pm$2.2 days. There was one post sympathetic neuralgia and one peritoneal opening. Conclusion: Lumbar sympathectomy using mediastinoscopy is a simple and effective technique and has the advantage of cosmetics, post operative pain and hospital stay. However, further studies with large number of cases should be carried out for better outcome.

키워드

참고문헌

  1. Lee DY, Yoon YH, Hoong YJ, Moon DS. Needle thoracoscopic sympathectomy for estential hiperhidrosis. Korean J Thorac Cadiovasc Surg 1998;31:598-603
  2. Kim IH, Kim KT, Lee IS, Kim HM, Kim HJ. Thoracoscopic sympathetic ganglionectomy for primary hypatidrosis. Korean J Thorac Cadiovasc Surg 1998;31:517-22
  3. Rennie JA. Compensatory sweating: An Avoidable Complication of Thoracoscopic Sympathectomy? Minimally Invas Ther Allied Technol 1996;5:101-4
  4. Gossort D, Toledo L, Fritsch S, et al. Thoracoscopic sympathectomy for upper limb hyperhidrosis: Looking for the right operation. Ann Thorac Surg 1997;64:975-8 https://doi.org/10.1016/S0003-4975(97)00799-6
  5. Kim KT. Plantar hyperhidrosis. Endoscopy (Hyperhidrosis) Symposium 1999;89-92
  6. Haimovici H, Callow AD, DePalma RG, Ernst CB, Hollieer LG. Lumbar sympathectomy. Haimovici's Vascular Surgery 3rd ed. Norwark: Appleton & Lange 1987;882-93
  7. Rutherford RB. Lumbar sympathectomy: Indications and technoque. Vascular Surgery 5th ed. Philadelphia: WB Saunder 2000;1069-78
  8. Pearson FG, Cooper JD, Deslauriers J, et al. Mediastinoscopy. In: Pearson FG, Cooper JD, Deslauriers J, et al. Thoracic Surgery. 2nd ed. New York: Churchill Livingstone 2002;98-103
  9. Ewing M. The history of lumbar sympathectomy. Surgery 1971;70:791-6
  10. Elliot TB, Royle JP. Laparoscopic extraperitoneal lumbar sympathectomy: Technique and Early Results. Aust N Z Surg 1996;66:400-2 https://doi.org/10.1111/j.1445-2197.1996.tb01218.x
  11. Bannberry JJG, Hourlay P, Meijer DW, Vangertruyden G. Retroperitoneal endoscopic lumbar sympathectomy: Laboratory and Clinical Experience. End Surg 1995;3:16-20
  12. Inderbir S, Gill RV, Clayman DM, et al. Retroperitoneal & pelvic extraperitoneal laoparoscopy: An International Perspective. Urology 1998;52:566-71 https://doi.org/10.1016/S0090-4295(98)00314-8
  13. Lacroiz H, Vander VG, Penninckx F, Nevelsteen A, Suy R. Technique and early results of videoscopic lumbar sympathectomy. Acta Chir Belg 1996;96:11-4
  14. Hourlay P, Vangertruyden G, Verdduyckt F, Trimpeneers F, Henddrckx J. Endoscopic extraperitoneal lumbar sympathectomy. Surg Endosc 1995;9:530-3