颈交感神经节的影像学成像进展及临床应用
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摘要
颈交感神经节(CSG)是颈部外周交感神经系统的重要组成部分,可通过对下丘脑内环境稳态的调理,实现对植物神经系统、内分泌系统和免疫系统功能的调节,其临床应用主要为CSG阻滞,通过对其区域阻滞,治疗疼痛、心律失常及失眠等多种临床症状。但临床操作时,常因不能有效识别CSG,而对其造成不可修复的损伤。随着医学成像技术的发展,尤其是高频超声的应用,可在进行颈部操作前,实现对CSG的辨识。通过综述CSG的解剖位置、CSG的影像学成像以及影像学在CSG阻滞中的临床应用,减少临床颈部操作可能对CSG的损伤,实现影像技术引导CSG的精确阻滞,提高颈交感神经阻滞的成功率,减少并发症。
Cervical sympathetic ganglion(CSG) is an important part of the peripheral sympathetic nervous system of neck. It can regulate the functions of the autonomic nervous system, endocrine system and immune system by regulating the homeostasis of the internal environment of the hypothalamus. Its clinical applications were mainly CSG block. Through its regional block, the multiple clinical symptoms included pain, arrhythmia and insomnia can be treated. However, in clinical operation, CSG is often unable to be effectively identified, resulting in irreparable damage to it. In recent years, with the development of medical imaging technology, especially the application of high-frequency ultrasound, CSG can be identified before neck operation. By summarized the anatomical location of CSG, iconography imaging of CSG and the clinical application of imaging in CSG block, not only the possible injury to CSG caused by clinical neck operation can be reduced, but also the accurate block of CSG guided by imaging technology can be realized, and the success rate of CSG block can be also improved, and the relative complications can be reduced.
Cervical sympathetic ganglion(CSG) is an important part of the peripheral sympathetic nervous system of neck. It can regulate the functions of the autonomic nervous system, endocrine system and immune system by regulating the homeostasis of the internal environment of the hypothalamus. Its clinical applications were mainly CSG block. Through its regional block, the multiple clinical symptoms included pain, arrhythmia and insomnia can be treated. However, in clinical operation, CSG is often unable to be effectively identified, resulting in irreparable damage to it. In recent years, with the development of medical imaging technology, especially the application of high-frequency ultrasound, CSG can be identified before neck operation. By summarized the anatomical location of CSG, iconography imaging of CSG and the clinical application of imaging in CSG block, not only the possible injury to CSG caused by clinical neck operation can be reduced, but also the accurate block of CSG guided by imaging technology can be realized, and the success rate of CSG block can be also improved, and the relative complications can be reduced.
引文
[1]岳修勤.颈交感神经节穿刺入路的应用解剖学研究及临床应用[D].广州:南方医科大学,2007.
[2]Shin JE,Baek JH,Ha EJ,et al.Ultrasound Features of Middle Cervical Sympathetic Ganglion[J].Clin J Pain,2015,31(10):909-913.
[3]Elias M.Cervical sympathetic and stellate ganglion blocks[J].Pain Physician,2000,3(3):294-304.
[4]Chaudhry A,Kamali A,Herzka DA,et al.Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging[J].AJNR Am J Neuroradiol,2018,39(8):1550-1554.
[5]Park C,Suh CH,Shin JE,et al.Characteristics of the Middle Cervical Sympathetic Ganglion:A Systematic Review and Meta-Analysis[J].Pain Physician,2018,21(1):9-18.
[6]Civelek E,Karasu A,Cansever T,et al.Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine[J].Eur Spine J,2008,17(8):991-995.
[7]Narouze S,Vydyanathan A,Patel N.Ultrasound-guided stellate ganglion block successfully prevented esophageal puncture[J].Pain Physician,2007,10(6):747-752.
[8]Kiray A,Arman C,Naderi S,et al.Surgical anatomy of the cervical sympathetic trunk[J].Clin Anat,2005,18(3):179-185.
[9]Katritsis ED,Lykaki-Anastopoulou G,Papadopoulos NJ.Anatomical observations on the intermediate ganglion of the cervical sympathetic trunk(based on 232 specimens)[J].Anat Anz,1983,154(1):33-38.
[10]Lee JH,Cheng KL,Choi YJ,et al.High-resolution Imaging of Neural Anatomy and Pathology of the Neck[J].Korean J Radiol,2017,18(1):180-193.
[11]Saylam CY,Ozgiray E,Orhan M,et al.Neuroanatomy of cervical sympathetic trunk: a cadaveric study[J].Clin Anat,2009,22(3):324-330.
[12]Kawashima T.The autonomic nervous system of the human heart with special reference to its origin, course,and peripheral distribution[J].Anat Embryol(Berl),2005,209(6):425-438.
[13]Yin Z,Yin J,Cai J,et al.Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli[J].J Biomed Res,2015,29(6):501-507.
[14]Ebraheim NA,Lu J,Yang H,et al.Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine[J].Spine(Phila Pa 1976),2000,25(13):1603-1606.
[15]Pishdad GR,Pishdad P,Pishdad R.Horner's syndrome as a complication of percutaneous ethanol treatment of thyroid nodule[J].Thyroid,2011,21(3):327-328.
[16]Messika O,Telman G.Horner syndrome after lymph node fine needle aspiration[J].Acta Cytol,2009,53(4):487-488.
[17]Na DG,Lee JH,Jung SL,et al.Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers:Consensus Statement and Recommendations[J].Korean J Radiol,2012,13(2):117-125.
[18]Katritsis ED,Lykaki-Anastopoulou G,Papadopoulos NJ.The relations of the superior pole of the stellate ganglion to the vertebral artery[J].Anat Anz,1981,150(3):259-263.
[19]Hogan QH,Erickson SJ.MR imaging of the stellate ganglion:normal appearance[J].AJR Am J Roentgenol,1992,158(3):655-659.
[20]Lee JY,Lee JH,Song JS,et al.Superior Cervical Sympathetic Ganglion:Normal Imaging Appearance on 3T-MRI[J].Korean J Radiol,2016,17(5):657-663.
[21]Siegenthaler A,Haug M,Eichenberger U,et al.Block of the Superior Cervical Ganglion,Description of a Novel Ultrasound-Guided Technique in Human Cadavers[J].Pain Med,2013,14(5):646-649.
[22]Erickson SJ,Hogan QH.CT-guided injection of the stellate ganglion:description of technique and efficacy of sympathetic blockade[J]. Radiology,1993,188(3):707-709.
[23]Abdi S,Zhou Y,Patel N,et al.A new and easy technique to block the stellate ganglion[J].Pain Physician,2004,7(3):327-331.
[24]Soneji N,Peng PW.Ultrasound-guided pain interventions-a review of techniques for peripheral nerves[J].Korean J Pain,2013,26(2):111-124.
[25]Kastler A,Aubry S,Sailley N,et al.CT-guided stellate ganglion blockade vs.radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb[J].Eur Radiol,2013,23(5):1316-1322.
[26]Kapral S,Krafft P,Gosch M,et al.Ultrasound imaging for stellate ganglion block:direct visualization of puncture site and local anesthetic spread.A pilot study[J].Reg Anesth,1995,20(4):323-328.
[27]Siegenthaler A,Mlekusch S,Schliessbach J,et al.Ultrasound imaging to estimate risk of esophageal and vascular puncture after conventional stellate ganglion block[J].Reg Anesth Pain Med,2012,37(2):224-227.
[28]Yoo SD,Jung SS,Kim HS,et al.Efficacy of Ultrasonography Guided Stellate Ganglion Blockade in the Stroke Patients with Complex Regional Pain Syndrome[J].Ann Rehabil Med,2012,36(5):633-639.
[29]Rastogi S,Tripathi S.Cardiac arrest following stellate ganglion block performed under ultrasound guidance[J].Anaesthesia,2010,65(10):1042-1042.
[30]Feigl GC,Rosmarin W,Stelzl A,et al.Comparisonof Different Injectate Volumes for Stellate Ganglion Block:An Anatomic and Radiologic Study[J].Reg Anesth Pain Med,2007,32(3):203-208.
[31]Slappendel R,Thijssen HO,Crul BJ,et al.The stellate ganglion in magnetic resonance imaging:a quantification of the anatomic variability[J].Anesthesiology,1995,83(2):424-426.
[32]Price DD,Long S,Wilsey B,et al.Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients[J].Clin J Pain,1998,14(3):216-226.
[2]Shin JE,Baek JH,Ha EJ,et al.Ultrasound Features of Middle Cervical Sympathetic Ganglion[J].Clin J Pain,2015,31(10):909-913.
[3]Elias M.Cervical sympathetic and stellate ganglion blocks[J].Pain Physician,2000,3(3):294-304.
[4]Chaudhry A,Kamali A,Herzka DA,et al.Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging[J].AJNR Am J Neuroradiol,2018,39(8):1550-1554.
[5]Park C,Suh CH,Shin JE,et al.Characteristics of the Middle Cervical Sympathetic Ganglion:A Systematic Review and Meta-Analysis[J].Pain Physician,2018,21(1):9-18.
[6]Civelek E,Karasu A,Cansever T,et al.Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine[J].Eur Spine J,2008,17(8):991-995.
[7]Narouze S,Vydyanathan A,Patel N.Ultrasound-guided stellate ganglion block successfully prevented esophageal puncture[J].Pain Physician,2007,10(6):747-752.
[8]Kiray A,Arman C,Naderi S,et al.Surgical anatomy of the cervical sympathetic trunk[J].Clin Anat,2005,18(3):179-185.
[9]Katritsis ED,Lykaki-Anastopoulou G,Papadopoulos NJ.Anatomical observations on the intermediate ganglion of the cervical sympathetic trunk(based on 232 specimens)[J].Anat Anz,1983,154(1):33-38.
[10]Lee JH,Cheng KL,Choi YJ,et al.High-resolution Imaging of Neural Anatomy and Pathology of the Neck[J].Korean J Radiol,2017,18(1):180-193.
[11]Saylam CY,Ozgiray E,Orhan M,et al.Neuroanatomy of cervical sympathetic trunk: a cadaveric study[J].Clin Anat,2009,22(3):324-330.
[12]Kawashima T.The autonomic nervous system of the human heart with special reference to its origin, course,and peripheral distribution[J].Anat Embryol(Berl),2005,209(6):425-438.
[13]Yin Z,Yin J,Cai J,et al.Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli[J].J Biomed Res,2015,29(6):501-507.
[14]Ebraheim NA,Lu J,Yang H,et al.Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine[J].Spine(Phila Pa 1976),2000,25(13):1603-1606.
[15]Pishdad GR,Pishdad P,Pishdad R.Horner's syndrome as a complication of percutaneous ethanol treatment of thyroid nodule[J].Thyroid,2011,21(3):327-328.
[16]Messika O,Telman G.Horner syndrome after lymph node fine needle aspiration[J].Acta Cytol,2009,53(4):487-488.
[17]Na DG,Lee JH,Jung SL,et al.Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers:Consensus Statement and Recommendations[J].Korean J Radiol,2012,13(2):117-125.
[18]Katritsis ED,Lykaki-Anastopoulou G,Papadopoulos NJ.The relations of the superior pole of the stellate ganglion to the vertebral artery[J].Anat Anz,1981,150(3):259-263.
[19]Hogan QH,Erickson SJ.MR imaging of the stellate ganglion:normal appearance[J].AJR Am J Roentgenol,1992,158(3):655-659.
[20]Lee JY,Lee JH,Song JS,et al.Superior Cervical Sympathetic Ganglion:Normal Imaging Appearance on 3T-MRI[J].Korean J Radiol,2016,17(5):657-663.
[21]Siegenthaler A,Haug M,Eichenberger U,et al.Block of the Superior Cervical Ganglion,Description of a Novel Ultrasound-Guided Technique in Human Cadavers[J].Pain Med,2013,14(5):646-649.
[22]Erickson SJ,Hogan QH.CT-guided injection of the stellate ganglion:description of technique and efficacy of sympathetic blockade[J]. Radiology,1993,188(3):707-709.
[23]Abdi S,Zhou Y,Patel N,et al.A new and easy technique to block the stellate ganglion[J].Pain Physician,2004,7(3):327-331.
[24]Soneji N,Peng PW.Ultrasound-guided pain interventions-a review of techniques for peripheral nerves[J].Korean J Pain,2013,26(2):111-124.
[25]Kastler A,Aubry S,Sailley N,et al.CT-guided stellate ganglion blockade vs.radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb[J].Eur Radiol,2013,23(5):1316-1322.
[26]Kapral S,Krafft P,Gosch M,et al.Ultrasound imaging for stellate ganglion block:direct visualization of puncture site and local anesthetic spread.A pilot study[J].Reg Anesth,1995,20(4):323-328.
[27]Siegenthaler A,Mlekusch S,Schliessbach J,et al.Ultrasound imaging to estimate risk of esophageal and vascular puncture after conventional stellate ganglion block[J].Reg Anesth Pain Med,2012,37(2):224-227.
[28]Yoo SD,Jung SS,Kim HS,et al.Efficacy of Ultrasonography Guided Stellate Ganglion Blockade in the Stroke Patients with Complex Regional Pain Syndrome[J].Ann Rehabil Med,2012,36(5):633-639.
[29]Rastogi S,Tripathi S.Cardiac arrest following stellate ganglion block performed under ultrasound guidance[J].Anaesthesia,2010,65(10):1042-1042.
[30]Feigl GC,Rosmarin W,Stelzl A,et al.Comparisonof Different Injectate Volumes for Stellate Ganglion Block:An Anatomic and Radiologic Study[J].Reg Anesth Pain Med,2007,32(3):203-208.
[31]Slappendel R,Thijssen HO,Crul BJ,et al.The stellate ganglion in magnetic resonance imaging:a quantification of the anatomic variability[J].Anesthesiology,1995,83(2):424-426.
[32]Price DD,Long S,Wilsey B,et al.Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients[J].Clin J Pain,1998,14(3):216-226.