Intraoperative monitoring of evoked potentials of thoracic sympathetic trunk

近年来，内窥镜胸椎交感神经切除术治疗掌多汗症的疗效得到了更密切的评价。我们采用胸交感干诱发电位来确定截肢面积，并评估交感阻滞的强度作为术中监测。16例中有13例观察到诱发电位。(16例患者中，2例为CRPS， 14例为多汗症。他们的年龄从14岁到65岁不等。)记录电刺激强度1 ~ 5ma，间隔13msec，持续时间0.1ms，训练次数170次时掌、腋窝、胸部、脚底的电位。通过刺激第2和第3肋交感干，仅在掌部记录到多相波。腋窝、胸部和脚底没有记录。交感神经切除后，虽然在第2肋上有刺激交感干的诱发电位，但在第3肋上的诱发电位消失。所有病例交感神经切除后，刺激Th2和Th3之间的交感干诱发电位均消失。该研究为内窥镜胸椎交感神经切除术的正确操作提供了额外的信息。

In recent years, the efficacy of endoscopic thoracic sympathectomy for palmar hyperhidrosis has been more closely evaluated. We have adopted the evoked potential of thoracic sympathetic trunk to determine the area of amptation and to evaluate the intensity of sympathetic blockade as an intraoperative monitoring. The evoked potential was observed in 13 cases of 16 cases. (Of the 16 patients studied, 2 were CRPS and 14 were hyperhidrosis. Their ages varied from 14 to 65 years.) The potentials evoked by the electrical stimulation (Intensity:1-5mA, Interval:13msec, Duration:0.1ms, Train:170 times.) were tried to be recorded on palm, axilla, chest, and sole. Multi-phasic waves were recorded only on palm by stimulating the sympathetic trunk on 2nd and 3rd rib. These were not recorded on axilla, chest, and sole. After sympathectomy, though the evoked potentials by stimulating the sympathetic trunk on 2nd rib were observed, those on 3rd rib were disappeared. The evoked potential by stimulating the sympathetic trunk between Th2 and Th3 was disappeared after sympathectomy in all cases. The study provides additional information as to the proper procedure of the endoscopic thoracic sympathectomy.