左T_4右T_3交感神经链切断术治疗手汗症

Right T_3 combined with left T_4 sympathectomy for primary palmar hyperhidrosis

目的探讨左T4右T3交感神经链切断术治疗手汗症的可行性。方法 2012年2月～2014年4月对63例手汗症行胸腔镜下胸交感神经链切断术,男27例,女36例,年龄15～42岁。术前随机分为3组：A组23例行左T4右T3切断,B组22例行双侧T3切断,C组18例行双侧T4切除。结果所有手术均顺利完成,无严重并发症和围手术期死亡病例。术后平均随访（10.6±9.5）个月,手掌多汗症状均改善。A组9例（39.1%）的左侧手掌,A组2例（8.7%）、B组2例（9.1%）和C组8例（44.4%）的双侧手掌仍潮湿；右手潮湿率A组明显低于C组（P〈0.01）,左手潮湿率B组明显低于A组（P〈0.01）；A、B组疗效满意率明显优于C组（P〈0.01）。66.7%（42/63）的患者出现代偿性多汗（CH）,无重度CH病例,A、C组以轻度CH为主,而B组中度CH发生率显著高于A、C组（P〈0.05）。以身体脊柱为界,A组未出现一侧CH明显多于另外一侧现象。结论左T4右T3切断术能达到与双侧T3切断类似的效果,既能改善患者生活质量,又能减轻CH发生率,是一种安全可靠的手术方法。

Objective To explore the feasibility of right T3 combined with left T4 sympathectomy for primary palmar hyperhidrosis（ PPH）. Methods 63 cases with PPH hospitalized in the period from Feb.,2012 to April,2014,27 male and 36 female,aged from 15 to 42,were randomly divided into 3 groups before thoracoscopic sympathectomy： group A（ n = 23）,group B（ n = 22） and group C（ n = 18）; left T4 combined with right T3 sympathectomy was performed in group A,bilateral T3 sympathectomy in group B and bilateral T4 symathectomy in group C. Results All the operations were successfully performed with no occurrence of serious complications and death in perioperative period; the average follow-up lasted for（ 10. 6 ± 9. 5） months; after surgery,moisture was found in the left palms of 9 cases in group A（ 39. 1%）,while in both palms of 2 cases in group A（ 8. 7%）,2 cases in group B（ 9. 1%） and 8cases in group C（ 44. 4%）; the rate of moisture of right palm in group A was much lower than that in group C（ P 〈 0. 01）,while the rate of moisture of left palm in group B was much lower than that in group A（ P〈 0. 01）; the curative effects in group A and group B were obviously superior to that in group C（ P 〈 0. 01）; compensatory hyperhidrosis（ CH） was found in 66. 7% of the patients（ 42 /63）with no severe CH,slight CH occurred mainly in group A and group C,while the occurrence of moderate CH in group B was significantly higher than those in group A and group C（ P〈 0. 05）; taking the spine as the demarcation line,no occurrence of more severe CH on one side than the other was found in group A. Conclusions Right T3 combined with left T4 sympathectomy is of the same effect with bilateral T3sympathectomy; it can improve the life quality of the patients and reduce the occurrence of CH; it is a safe and reliable surgical method.