THE FIRST EXPERIENCE OF VIDEO-THORACOSCOPIC UPPER-PECTORAL SYMPATHECTOMY UNDER THE RAYNAUD’S PHENOMENON

Abstract

Objective: To study the results of the first experience of endoscopic upper-pectoral sympathectomy (UPS) under the Raynaud’s phenomenon. Methods: The results of the performance of video thoracoscopic UPS in 16 patients with the idiopathic form of the Raynaud’s phenomenon are analyzed. Women were 12 (75%), men – 4 (25%) at the age of 14 to 24 years (the average age was 24.9±3.7 years). All patients had a second stage of the disease with symptoms of chronic ischemia of hands II-III degrees. The average duration of the onset of the disease till the operative treatment was 3.2±0.4 years. Results: A characteristic clinical sign of the disease was the symmetrical affection of the hands with the phenomena of cyanosis, hyperemia, mottled skin and hyperhidrosis. According to Doppler Scan, in all cases, a decrease in the linear velocity of the blood flow in the arteries of the forearm, hand and fingers, increasing of index resistibility with reduction of the pulsating index. All 16 patients underwent videothoracoscopic UPS. The duration of the operation was 98.5±10.5 min. Intra- and postoperative complications were not observed. In the nearest postoperative period no complications were observed, the regress of Raynaud’s symptoms was noted, an increase in the blood flow velocity was recorded in the arteries of the hands and fingers in the Ultrasound Diagnostic. A year later, in the cold season, a part of patients (n=3) again have moderate signs of the disease; these patients underwent complex conservative therapy. Remote results are in the studying stage. Conclusion: The UPS, by any means, is performed, is an effective and reasonable procedure. Timely surgical treatment prevents the progression of the disease and the development of complications and improves the quality of life of patients.

Keywords

• raynaud phenomenon
• hand’s ischemia
• sympathectomy
• video-thoracoscopy.