單側交感神經截斷術不預期治癒雙側交感神經失養症－－病例報告

Unexpected Cure of Bilateral Reflex Sympathetic Dystrophy as a Result of a Unilateral Surgical Sympathectomy

此病例在創傷後雙側上肢遭受痛覺過度敏感、腫脹與僵硬，多種藥物治療效果不彰。根據臨床症狀，診斷為反射性交感神經失養症。星狀神經節阻斷術及持續頸部硬脊膜外阻斷術均可有效控制病人的疼痛使其能接受復健，但兩種方式都無法長期緩解疼痛。我們採用了外科交感神經切斷術’因患者右側肋膜沾黏手術僅能施行於左側，超乎預期的，患者雙手疼痛的症狀均大幅改善。因此我們可知，交地神經切斷術在經過特定篩選的反射性交感神經失養症患者身上能達到有效的疼痛控制。

A case with trauma history suffered from hyperalgesia, swelling and stiffuess over bilateral upper extremities, numerous medications treatments were unsuccessful. Based on her clinical presentation, reflex sympathetic dystrophy (RSD) was diagnosed. Both of stellate ganglion blocks and continuous cervical epidural block were effective and enable the patient to rehabilitate, but the methods didn' t provide the long-term pain relief. Thoracoscopic sympathectomy (TS} was carried out only on left side because of right pleural adhesion. Unexpectedly her conditions were great improved in the both hands. Conclusively, TS was still an effective pain management regimen in highly selective cases with RSD.