手足多汗症胸腔镜下交感神经链切断术后代偿性出汗的多因素分析

A Multivariate Analysis of the Incidence of Compensatory Hyperhidrosis after Thoracoscopic Sympathectomy for Palmar and Foot Hyperhidrosis

目的探讨手足多汗症胸腔镜下交感神经链切断术后代偿性出汗的影响因素。方法回顾性分析我院2006年8月～2011年12月345例手足多汗症行胸腔镜下交感神经链切断术的临床资料,对术后代偿性出汗的有关因素进行单因素和多因素分析。结果代偿性出汗发生率23.5%(81/345),T2～4组和T3～4组分别为29.5%(39/132)、19.7%(42/213)。单因素分析显示性别、治疗年龄、BMI、手汗程度、手术方式、手温上升程度与代偿性出汗程度有关(P<0.05)。多因素logistic回归分析显示,代偿性出汗的影响因素有性别(β=0.551,P=0.039,95%CI:1.085～2.965)、BMI(β=1.020,P=0.046,95%CI:1.053～4.646)、手汗程度(β=0.671,P=0.048,95%CI:1.138～3.633)和手术方式(β=1.424,P=0.001,95%CI:1.032～2.825)。结论性别、手汗程度、BMI和手术方式是胸腔镜下交感神经链切断术后代偿性出汗的影响因素,即女性、重度手汗、BMI>24以及切除T2～4的患者术后代偿性出汗发生率高。

Objective To explore the factors influencing compensatory hyperhidrosis after thoracoscopic sympathectomy in the treatment of palmar and foot hyperhydrosis. Methods The clinical data of 345 patients with palmar and foot hyperhidrosis from August 2006 to December 2011 were collected and the correlative factors influencing compensatory hyperhidrosis were analyzed by univariate and multivariate analysis. Results The incidence of compensatory hyperhidrosis was 23. 5% （81/345） , including 29.5% （39/132） for T2-4 group and 19.7% （42/213）for T3-4 group respectively. Univariate analysis revealed that the following factors were related with compensatory hyperhidrosis： gender, age, BMI, degree of hyperhydrosis, operation method and rising degree of hand temperature （ P 〈 0.05 ）. Multivariate analysis showed that gender （β = 0. 551, P = 0. 039, 95% CI. 1. 085 - 2. 965 ） , BMI （β = 1.020, P =0. 046, 95% CI：I. 053 - 4. 646）, degree of hyperhydrosis （β = 0. 671, P = 0. 048, 95% CI：1. 138 - 3. 633） and surgical method（β = 1. 424, P = 0. 001 , 95% CI： 1. 032 - 2. 825 ） were the major factors influencing compensatory hyperhidrosis. Conclusions Gender, BMI, degree of hyperhydrosis and surgical method are the factors influencing compensatory hyperhidrosis after thoracoscopic sympathectomy. Female patients, patients with severe hyperhydrosis, patients with BMI 〉 24, and patients undergoing T2-4resection have higher incidence of postoperative compensatory hyperhidrosis.