胸腔镜下单孔胸交感神经链切断术治疗原发性手汗症

Thoracoscopic sympathectomy with one operative incision for palmar hyperhidrosis

目的探讨电视胸腔镜下单孔胸交感神经链切断术治疗原发性手汗症的疗效和安全性。方法 2009年4月至2011年12月,80例原发性手汗症患者在胸腔镜下单孔操作,分别行T2～T5不同节段交感神经链切断术,术中持续监测双手掌温以判断手术疗效,随访症状缓解情况、有无复发以及代偿性出汗情况。结果全组病例手术均获成功,平均手术时间为(49.8±4.2)min,术后患者手掌多汗症状消失,双手转为干燥温暖状,双手掌皮肤温度均较术前显著升高(P<0.05),无严重并发症发生。77例患者随访1～32月,平均16.8月。1例单手手汗复发,已再次手术治愈。发生代偿性多汗38例(47.5%),其中中度出汗2例,轻度出汗36例。行单纯T3、T4或联合T3+T4胸交感神经链切断者代偿性多汗发生率为42.6%(29/68);余节段切断者代偿性多汗发生率为75.0%(9/12)。结论胸腔镜下单孔胸交感神经链切断术治疗手汗症具有操作简单、安全有效、创伤小等特点,值得临床推广。

Objective To discuss the therapeutic efficacy and safety of thoracoscopic sympathectomy from one operative incision in treatment of patients with palmar hyperhidrosis.Methods From April 2009 to December 2011,80 patients with palmar hyperhidrosis underwent bilateral thoracoscopic sympathectomy with one operative incision at different segments of T2-T5.Palmar temperature was measured to observe the curative effects of sympathectomy during the operation.The following information were obtained during follow up：symptoms associated or recurrenced with hyperhidrosis and compensatory sweating（CS）.Results The operation was completed successfully in 80 patients.The mean operation time was（49.8±4.2）minutes.Symptoms of hyperhidrosis disappeared and the palmar temperature of both hands increased significantly（P0.05） in all patients without serious complications after operations.77 patients were followed up for 1-32 months（mean 16.8 months） and one hand of a patient had recurrence.It had been treated successfully with the second operation.38 of 80 patients（47.5%） had CS,2 had moderate CS and 36 had minor CS.The CS rate of undergoing T3,T4 or T3-4 sympathectomy was 42.6%（29/68） and that of undergoing other segments sympathectomy was 75.0%（9/12）.Conclusion Thoracoscopic sympathectomy with one operative incision for palmar hyperhidrosis is simply,safe effective,minimally invasive and worthy of clinical promoted application.