T4交感神经链切断术治疗原发性手汗症

Outcomes analysis of T4 sympathicotomy in the treatment of primary palmar hyperbidroesis

目的探讨T4交感神经链切断术在原发性手汗症治疗中的效果。方法80例原发性手汗症病人中男45例，女35例；平均年龄27．1岁（17—55岁）。采用电视胸腔镜T4交感神经链切断术治疗。全身麻醉，交感神经链切断选择在第4肋骨表面水平单一位置，同时切断旁路传导纤维。结果全组无严重手术并发症及死亡。术后出现少量气胸2例，皮下气肿6例。随访6—29个月，平均16．5个月。全组有效率100％。30例术后手掌完全干燥；46例在天气过热等情况下掌心稍有潮湿，类似于健康人状态，不影响正常生活，4例手掌出汗部分改善。31例术后有躯体出汗增多，其中29例症状轻微，对情绪及生活无影响，2例感到不适，但可耐受。1例手掌过于干燥。全组“非常满意”或“满意”76例，“基本满意”4例。“非常满意”率在术后手掌偶有潮湿者中为73．9％（34／46例），显著高于术后手掌完全干燥者（10／30例，33．3％），P〈0．01。结论T4交感神经链切断术治疗原发性手汗症操作简单、副作用小、病人满意度高，是一种值得推荐的术式。

Objective To analysis the outcome of T4 sympathicotomy in the treatment of primary palmar hyperhidrosis. Methods From September 2004 to February 2008, eighty patients with primary palmar hyperhidrosis, including 45 males and 35 females with average age of 17.1 years, underwent T4 sympathicetomy, in which the sympathetic chains were transected at the level of the forth ribs. Results The procedures were suecessful. There were no severe intro- and post-operative complications or and mortality. Post-operative complications included mild pneumothorax in two patients and pneumederma, in six patients. A mean follow-up of was 16.5 months（6- 29 months）and the symptom ofshowed palmar sweating was improved in all patients relieved in their palmar sweating, with effective rate of 100%. 46 patients（57.5% ）resulted inhad mild moisture hand of but not influence to the daily life, and 4 patients（5% ）got developed partial remission. Compensatory sweating occttrred in 31 patients（38.8% ）, but only 2 cases（2.5% ） complained with this side effect. Over-dry hands occurred in 1 case（1.25% ）. 95% of patients were ＂very satisfied＂ or ＂satisfied＂ with the outcome of the operation. 5 % patients were ＂partially satisfied＂. The rate of ＂very very satisfied＂ rate was much higher in patients with mild moisture hands than patients with dry hands （ 73.9 % vs 33.3 %, P 〈 0.01 ）. Conclusion T4 sympathicotomy is a simplified mothod with little side effect and higher satisfactory rate. It should be recommended for the treatment of primary palmar hyperhidrosis.