电视胸腔镜胸交感干并旁路纤维切断术治疗手汗症355例分析

Video-assisted thoracoscopic sympathictomy plus bypass fiber resection for 355 patients with palmar hyperhidrosis

目的：探讨电视胸腔镜胸交感干并旁路纤维切断术治疗手汗症的疗效和预防术后并发症的措施。方法：2005年5月至2008年11月我科共施行355例手汗症手术,按是否保留胸2交感神经干分为T2~4组（n=218）和T3~4组（n=137）,对相关临床资料进行比较分析。结果：全组无手术死亡和严重并发症。术后手掌多汗症状消失,无复发病例。术后随访T2~4组转移性代偿性多汗的发生率为2.3%,而T3~4组为5.1%,差异具有显著性（χ2=23.17,P〈0.01）。结论：电视胸腔镜胸交感干并旁路纤维切断术是治疗手汗症安全有效的微创方法,保留T2能有效降低术后代偿性多汗的发生率。

Objective：To evaluate the efficiency of Video-assisted thoracoscopic sympathictomy plus bypass fiber resection for palmar hyperhidrosis and introduce the experience regarding the prevention of related postoperative complication. Methods ：The clinical data of 355 cases of primary palmar hyperhidrosis who underwent bilateral Video-assisted thoracoscopic sympathictomy plus bypass fiber resection from May 2005 to November 2008 was analyzed retrospectively. The curative results as well as incidence of postoperative compensatory hyperhidrosis （CH）were compared between T 2~4 group undergoing T 2~4 sympathictomy （n=218）and T 3~4 group undergoing T 3~4 sympathictomy（n=137）. Results：Operation was successfully performed on all patients and their palmar hyperhidrosis was completely alleviated after operation. No surgery-related postoperative severe complication occurred. The CH rate of T 3~4 group was 5.1%,significantly lower than that of T 2~4 group （23.9% ,P 0.01）. Conclusion：Video-assisted thoracoscopic sympathictomy is an effective,safe and minimally invasive procedure for palmar hyperhidrosis.Denervation at lower level （T 3~4 instead of T 2~4 ）appears associated with less severe CH in postoperative period.