胸腔镜下T_(3～4)交感神经干切断术治疗原发性手足多汗症的优势分析

Advantages of T_(3-4) sympathicotomy performed by video-assisted thoracoscopic surgery for primary palmoplantar hyperhidrosis

目的:比较胸腔镜下T_(3-4)与T_3两种不同水平交感神经干切断术对手、足出汗的缓解情况和发生代偿性多汗的异同,分析前者的临床应用优势。方法:回顾性对我科2007年7月至2008年12月开展的胸腔镜下胸上段交感神经干切断术160例临床资料进行对照分析,按不同手术方式分为T_(3-4)组(行L_(3-4)水平胸交感神经干切断术,共93例)和T_3组(行T_3水平交感神经干切断术,共67例)。分别对两组病例进行随访,比较两组之间手掌、足底出汗的疗效以及代偿性多汗的异同。结果:两组手多汗有效率均为100%,无复发病例;足底多汗有效率分别为89.4%、73.1%,差异有统计学意义(x^2=6.717,P<0.05);轻-中度代偿性多汗发生率分别为16.1%和15.4%,差异无统计学意义(x^2=0.222,P>0.05),无重度代偿性多汗。结论:T_(3-4)交感神经干切断术能有效治疗手出汗的同时,明显提高足底多汗的缓解率,并不增加代偿性多汗的发生率,是一种较为理想的手术方式。

Objective To study the effect of video-assisted thoracoscopic surgery （VATS） for primary palmoplantar hyperhidrosis by T3- 4 versus T3 sympathicotomy. Methods The clinical data of 160 cases, whom underwent bilateral sympathicotomy from July 2007 to December 2008, were analyzed retrospectively. 93 cases of them were pferformed VATS T3- 4 sympathicotomy, 67 cases of them were pferfomaed VATS T3 sympathicotomy. All the patients were evaluated by follow-up on the curative effect and occurrence of compensatory sweating. Results Both groups achieved 100% curative effect, no recurrent cases. The incidence of light-moderate compensatory sweating were 16.1% in T3-4 group, 15.4% in T3 group（Х^2 = 0.222,P 〉 0.05）, no severe compensatory sweating. The efficiency of plantar hyperhidrosis were 89.4%, 73.1% respectively, there was a significant difference between them （Х^2 = 6.717, P〈0.05）. Conelutions The T3- 4 sympathicotomy is a reasonable treatment method for palmoplantar hyperhidrosis, it could achieve satisfactory effects of palmar hyperhidrosis, and increase the curing efficiency of plantar hyperhidrosis.