Lumbar sympathectomy

Lumbar sympathectomy is suitable for patients with first or second stage of stenosis or occlusion of the radial artery. The short-term effect is still satisfactory, but the long-term effect is not ideal. Treatment of diseases: radial artery injury, vascular stagnation syndrome Indication (1) Lower extremity thromboangiitis obliterans, burning neuralgia and other symptoms are heavier, the general method is not effective. (2) Through lumbar sympathetic block, the clinical symptoms are obviously improved or disappeared. Surgical procedure General anesthesia or epidural anesthesia is most commonly used. Take the supine position, the surgical side of the waist pad with sandbags, so that the body tilts at an angle of 30 ° with the operating table. Or lateral position, the knee joint under the sandbag, so that the knee and ankle joint slightly flexed. (1) Skin incision: There are two kinds, one is the longitudinal incision of the lower back, starting from the rib of the posterior iliac crest, proceeding downwards, and stopping slightly below the plane of the anterior superior iliac crest. The other is an oblique oblique incision of the lateral abdomen, from the lower edge of the midline of the iliac crest, along the direction of the external oblique muscle, tangential to the outer edge of the rectus abdominis. The latter method is more useful. (2) Abdominal muscle incision: After cutting the skin, subcutaneous fat and deep fascia, and then along the direction of the muscle fibers, the external oblique muscle, the intra-abdominal oblique muscle and the transverse abdominis muscle are respectively cut into the extraperitoneal fat layer. (3) Exposing the lumbar sympathetic ganglia: with the deep peritoneal retractor with the peritoneal sac and the contents of the abdominal cavity, gently peel off the inside with your fingers, find the inner edge of the lumbar muscle and the psoas muscle, and the ureter with the peritoneum in the peritoneum Push away. Along the inner edge of the psoas muscle, the inferior vena cava can be found on the right side of the surgery, and the abdominal aorta is found on the left side. The right side is in the gap between the inner edge of the psoas muscle and the inferior vena cava, and the left side is in the gap between the inner edge of the psoas muscle and the abdominal aorta, and the blunt dissection is performed. Be careful not to damage the lumbar motion, the vein, and the fat. Find the sympathetic trunk in the cell tissue of the lymph nodes, and find the sympathetic ganglia along the sympathetic trunk. The sympathetic trunk on the left side is located on the slightly outer side of the abdominal aorta, and can be revealed; the sympathetic trunk on the right side is mostly covered by the inferior vena cava, and the inferior vena cava should be pushed to the midline to expose the sympathetic stem. (4) After sympathectomy, the sympathetic trunk and ganglia are revealed. For the purpose of improving the blood of the foot, it is enough to remove the 2nd and 3rd lumbar segments. Sometimes the third, third, and fourth waist sections are removed. The fourth lumbar sympathetic nerve is located below the left common iliac artery near the aortic branch. The traffic branch of the 2nd lumbar section is going up, the traffic branch of the 3rd lumbar section is running horizontally, and the traffic branch of the 4th lumbar section is going down. After exposing the fourth lumbar sympathetic ganglia, the hemostatic forceps were used to clamp the sympathetic nerve branch around the ganglion. The fourth lumbar section was used as the traction, and the upper part was separated upwards to the upper side of the second lumbar section, and the sympathetic trunk was cut off, and the second, third, and fourth lumbar segments and their associated nerve trunks were removed together. If you need to remove the first lumbar section, you should find it along the sympathetic trunk and at the foot of the diaphragm. If you need bilateral surgery, you can do another surgery 2 to 3 weeks after the first surgery. In the case of surgery on both sides, the male patient must retain the first lumbar sympathetic ganglia on one side, as it is related to ejaculation. Most of the preganglionic fibers of the lumbar sympathetic ganglia pass through the second lumbar region, so the second lumbar resection is the most important. (5) After thorough hemostasis, the layers of muscle, fascia, subcutaneous fat and skin incision were layered and sutured. complication (1) weakened bowel movements or intestinal paralysis. (2) When the first lumbar sympathetic ganglion is removed on both sides, ejaculation disorder is prone to occur.