单孔法胸腔镜下交感神经链切断术治疗原发性手汗症35例报告

Mini-thoracoscopic Bilateral Cervical Sympathectomy with a Single Trocar for Primary Palmar Hyperhidrosis

目的探讨单孔法胸腔镜下胸交感神经链切断术治疗手汗症的可行性和安全性。方法 2008年1月～2010年10月应用单孔法胸腔镜下行胸交感神经链切断术治疗手汗症35例。术中准确定位T3和T4交感神经节位置,在同一10mm trocar内置入微型胸腔镜和电凝钩,在第3或第4肋骨头表面将交感神经链电灼切断,并沿该肋骨表面向外侧延伸2～3cm以切断可能存在的旁路上传神经纤维。分别于交感神经链切断前后记录掌温变化。结果 35例均在胸腔镜下完成单孔手术,未出现术后出血、切口感染、血气胸、心动过缓以及霍纳氏综合征等并发症。双侧手术时间25～56 min,平均32 min。掌温升高(2.5±0.6)℃。术后住院1～4 d,平均2.5 d。术后第2～3天出现轻度代偿性出汗3例,部位分别在背部和大腿,7～15 d自行缓解消失。35例术后随访1～34个月,平均20.4月,术后双手多汗症状完全消失,并由湿冷转为干燥,温暖而红润,有效率达100%(35/35);腋窝和足底多汗症状的缓解率分别达92.3%(24/26)和82.7%(24/29)。结论 单孔法胸腔镜下胸交感神经链切断术治疗原发性手汗症微创、安全简便、定位准确、疗效确切、切口隐蔽美观,符合美学要求,可在临床推广应用。

Objective To assess the technical feasibility and safety of mini-thoracoscopic bilateral cervical sympathectomy via one incision for the treatment of palmar hyperhidrosis. Methods A retrospective review of 35 patients（21 males and 14 females with a mean age of 24.3 years） who underwent single-port mini-thoracoscopic bilateral cervical sympathectomy between January 2008 and October 2010 was conducted.During the procedure,we accurately positioned the T3 and T4 sympathetic ganglion,and then inserted a mini-thoracoscope and electric coagulation hook via a same 10-mm trocar to cut the sympathetic chain on the surface of the third or fourth rib head,as well as the possibly existed afferent branchial nerves along the rib,2-3 cm away the rib head.The palm temperature was measured before and after exciding the ganglion and the nerves. Results The procedure was completed successfully in all the 35 patients without leading to postoperative hemorrhage,infection,pneumohemothorax,tachycardia,and Horner＇s syndrome.The time for bilateral operation ranged from 25 to 56 min with a mean of 32 min.The palm temperature increased by a mean of（2.5±0.6） ℃ after the surgery.The patients were discharged from our hospital in 1 to 4 days postoperation（mean,2.5 days）.Among the patients,compensatory sweating on the back or thigh occurred in three cases at days 2 to 3 postoperation,and was cured spontaneously in 7 to 15 days.Follow-up was achieved in 35 patients for a mean of 20.4 months（1-34 months）,during which all the cases showed warm and dry palms without hyperhidrosis（effective rate 100%）;meanwhile the remission rate of the axillary and feet hyperhidrosis were 92.3%（24/26） and 82.7%（24/29）,respectively. Conclusions Mini-thoracoscopic single-trocar bilateral cervical sympathectomy is a minimal invasive,effective,convenient and safe procedure with accurate positioning of the ganglion and good cosmetic outcomes for patients with palmar hyperhidrosis.