手汗症患者胸交感神经切断术后交感神经皮肤反应的观察

Sympathetic skin responses after thoracic sympathicotomy in patients with palmar hyperhidrosis

目的 探讨手汗症患者胸交感神经切断术前、后胸交感神经皮肤反应及其在临床中的应用价值。方法 2 0例手汗症患者取仰卧位 ,电刺激右正中神经后在右手掌、足底 ,左手掌、足底同时记录皮肤反应 ,并测定皮肤温度。均在胸腔镜下行第 2、3胸交感神经切断术。结果 2 0例患者均获得满意疗效 ,术后有 5例发生少量气胸 ,均自然吸收。随访无复发 ,但 10例 (5 0 % )发生代偿性多汗症。术后均可见交感神经皮肤反应的变化 ,16例 (80 % )双手交感神经皮肤反应完全消失 ,4例潜伏期显著延迟 ,振幅也显著降低。术后 1个月受检的 2例患者与术后 1d受检的患者得到的结果相似。皮肤温度在术前比正常低者 ,术后均上升 ,前后比较有显著性差异 (P <0 .0 5 ) ;温度的上升双手比双脚显著。结论 交感神经皮肤反应测定可作为手汗症患者的术后效果评价及复发判定的客观指标。

Objective To explore the sympathetic skin responses(SSR) of the thoracic sympathicotomy in hyperhidrosis patients and its clinical significance.Methods The recording of SSR was performed on 20 patients suffering from palmar hyperhidrosis before and after thoracic sympathicotomy.Electrical stimuli on the right median nerve was made on patients in supine position and results were recorded on right and left palms and soles at the same time by 4 channels.Skin temperature was also monitored simultaneously.T2 and T3 sympathicotomy was performed with VATS in each patient.Results All patients had symptomatic improvement with satisfaction.There was minimal residual pneumothorat in 5 patients but it was absorbed spontaneously.There was no recurrence during follow-up period and ten patients(50%) complained compensatory hyperhidrosis.After operation,SSR changes were shown in all patients.Abolition of SSR on both palms was achieved in 16 patients(80%).In the other 4 patients,the latencies were significantly delayed and the amplitudes were significantly reduced at both palms and soles.In two patients who were examined one month later after operation,similar results with postoperative SSRs were shown.The postoperative skin temperature of both palms and soles was lower than normal temperature postoperatively,and the tempeatare of both palms were increased higher than on the sole.Conclusion The recording of SSR may be useful to assess the effects of sympathicotomy and the follow-up of recurrence in hyperhidrosis patients.