不同节段胸交感神经干切断术治疗手汗症的疗效比较

Comparison of curative effects of sympathicotomy at different segments on palmar hyperhidrosis

目的探讨不同节段胸交感神经切断术治疗手汗症的疗效和术后代偿性多汗的差异。方法2003年1月至2006年6月开展胸腔镜下交感神经干切断术400例（2例因严重胸膜粘连放弃右侧手术），将398例分为3组。A组：T（2-4）胸交感神经干切断207例；B组：T3胸交感神经干切断131例；C组：L（3-4）胸交感神经干切断60例。结果各组均获成功，术后手掌多汗症状全部消失，术后无严重并发症。B组和C组术后代偿性多汗分别为5．3％和6．7％，差异无统计学意义，B＋C组和A组术后代偿性多汗分别为5．8％和28．0％，差异有统计学意义（x^2=32．812，P〈0．01），B＋C组术后代偿性多汗发生率明显降低。结论T3或T（3-4）胸交感干切断术治疗手汗症疗效可靠，能有效减少术后代偿性多汗的发生和提高患者的术后生活质量。

Objective To compare the curative effects of sympathicotomy at different segments on palmar hyperhidrosis. Methods Four hundred patients with palmar hyperhidrosis, 191 males and 209 females, aged 21. 9 ± 3.4 （10 ± 53 ）, underwent bilateral sympathicotomy However, bilateral sympathicotomy was forced to be given up and replaced by unilateral sympathicotomy in 2 patients because of severe pleural adhesion The 398 patients on which bilateral sympathicotomy was successfully performed were randomly divided into 3 groups ： Group A （ n = 207 ） undergoing T2-4 sympathicotomy, Group B （ n = 131 ） undergoing T3 sympathicotomy,, and Group C （ n = 60 ） undergoing T3-4 sympathicotomy. The curative effects were compared. Results Operation was successfully performed on all patients and their palmar hyperhidrosis was completely alleviated after operation. No surgery-related post-operative complication occurred. The compensatory hyperhidrosis （CH） rate of Group B was 5.3% , not significantly different from that of GroupC （6.7%, P 〉0.05）. The CH rate of the combined group, Group B ＋C was 5. 8%, significantly lower than that of Group A （28.0% , P 〈 0.01 ）. Conclusion Safe and mini-invasive, T3 or T3-4 sympathicotomy effectively reduce the development of CH and improves the patients＇ quality of life postoperatively.