不同节段交感神经干切断术治疗手汗症术后疼痛疗效比较

Compare the postoperative pain in different segments of sympathectomy treating of palmar hyperhidrosis

目的：比较针形胸腔镜下T2-4和T3-4不同节段交感神经干切断术治疗手汗症术后疼痛的疗效。方法：总结分析2007年12月—2009年6月期间完成的166例手足多汗症患者术后当天疼痛情况、止痛药应用情况及术后1个月疼痛情况。依据切断交感神经节段的不同分为两组。A组：行双侧T2-4交感神经干切断术,共66例;B组：行双侧T3-4交感神经干切断术,共100例。结果：两组手术均顺利完成,A组和B组手术当天疼痛的发生率分别为48.5%（32/66）、17.0%（17/100）,A组中重度疼痛的发生率及使用止痛药物（曲马多）的剂量明显高于B组。A组和B组术后1个月疼痛的发生率分别为16.7%（11/66）、3.0%（3/100）,A组明显高于B组（P=0.002）,两组术后疼痛程度差异无统计学意义（P=0.51）。结论：T3-4交感神经干切断术治疗手汗症术后疼痛发生率较低,疼痛程度较轻,使用止痛药物剂量较少。

Objective：To compare postoperative pain of the needle thoracoscopic T2～4 and T3～4 in different segments of sympathectomy in the treatment of palmar hyperhidrosis.Methods：From December 2007 to June 2009,we have completed 166 cases of palmar hyperhidrosis.We concluded the postoperative pain during the postoperative days and one month after operation,at the same time,we recorded the dose of analgesic drugs.Based on segments of different cut off the sympathetic ganglion was divided into two groups,A Group：bilateral T2～4 sympathectomy,66 cases.B group：bilateral T3～4 sympathectomy,100 cases.Results：The operation was successful finished in the two groups,in the postoperative day,the incidence of pain in A group and B group were 48.5%（32/66）,17.0%（17/100）,moderate to severe pain in A group and the use of anodyne（tramadol） were significantly higher than B group.One month after operation,the incidence of pain in A group and B group were 16.2%（11/66）,3.0%（3/100）,the A group was significantly higher than the B group（P=0.002）,the degree of postoperative pain in two groups were no significant difference（P=0.51）.Conclusion：T3～4 sympathectomy for treatment of palmar hyperhidrosis had lower incidence of postoperative pain and lesser degree of pain,using fewer doses of analgesic drugs.