胸腔镜T_2交感神经干阻断术治疗头面部多汗症随访与疗效评估

Long term follow-up study of craniofacial hyperhidrosis treated by blocking thoracic sympathetic trunk T2 with thoracoscope surgery

目的：评价电视胸腔镜行双侧胸交感神经链T2节段阻断术治疗头面部多汗的远期疗效及术后生活质量。方法2002-01至2007-12，通过阻断T2交感神经干的手术方式治疗头面部多汗症20例，每年进行定期电话随访，最近一次随访时间为2014-06，术后最短随访时间均超过5年。结果20例头面部多汗患者，手术持续时间30～45 min，平均（37．5±7） min。术后头汗消失率为100％，代偿性出汗总发生率为100％。代偿性出汗主要集中在后背和前胸，分别为96．7％，100％。其他部位如腹部、大腿也存在不同程度的代偿性出汗。随访结果对于手术效果“满意”10人（50％），“一般”7人（35％），“不满意”3人（15％）。术后生活质量明显改善9人（45％），改善8人（40％），无改善3人（15％）。结论胸腔镜下阻断T2交感神经干治疗头汗症效果确实，但术后出现代偿性多汗不可避免，对术后生活质量和心理影响较大，应谨慎实施这类手术。

Objective By long term follow-up study to investigate the curative effect and life quality of video-assisted thoraco-scopic T2 sympathetic trunk blocking in the treatment of craniofacial hyperhidrosis.Methods From January 2002 to December 2007, the clinical data of 20 cases were followed up, follow-up with telephone inquiries proceeded every year, the last follow-up time was Junuary 2014, a minimum exceeded five years of follow-up.Results The mean operating time was （37.5 ±7） min （ range,30 to 45 min） .Symptoms of craniofacial hyperhidrosis disappeared in all patients.The rates of postoperative compensatory sweating on back and chest were 96.7%, 100%, the other parts of the body like belly and leg had different degrees of compensatory sweating.The rate of satisfaction about operation was 50 percent （10 patients） , the rate of general view was 35 percent （7 patients） , the rate of dissatisfac-tion was 15 percent （3 patients）.The postoperative quality of life got“obvious better” in 9 patients （45 percent）,“better” in 8 pa-tients （40 percent） ,“no better” in 3 patients （15 percent） .Conclusions Endoscopic thoracic of T2 sympathetic trunk blocking for craniofacial hyperhidrosis is effective.The operation improves patients’ quality of life and gives satisfactory outcomes, But, all patients should be informed of compensatory hyperhidrosis before performing the operation.