CT引导下胸交感神经调制治疗腋下多汗症

Effectiveness of thoracic sympathetic nerve modulation guided by CT on axillary hyperhidrosis

目的观察CT引导下胸交感神经调制治疗腋下多汗症的临床效果。方法 2011年3月—2013年3月间在浙江省嘉兴市第一医院接受CT引导下胸交感神经调制治疗的腋下多汗症患者28例,在CT引导下经皮T4/5椎间隙穿刺,直至针尖抵达第5肋骨小头上缘(合并手汗者选T3/4椎体间隙,合并脚汗者同时选L2/3椎体间隙进针,针尖分别抵达第4肋骨小头上缘和L3椎体前外侧)。注入含造影剂碘海醇的1%利多卡因2 ml,观察所注药液分布在第5肋骨小头前方、T4/5椎体前侧方的壁胸膜外(合并脚汗者药液尚需覆盖L3椎体前侧方的腰交感神经),患者双手小指末梢灌注指数和腋窝温度上升1.5℃以上,即于20 min后每侧注入无水酒精2.5 ml(合并脚汗者每侧腰交感另加无水酒精5 ml)。结果 CT能精准引导穿刺针抵达第5或4肋骨小头上方及L3椎体前侧方,注入局麻药5 min后双手小指末梢灌注指数上升了(6.69±1.58)倍,腋窝温度平均上升(1.78±0.26)℃,且患者腋下多汗完全消失。注入无水酒精后,患者的末梢灌注指数和腋窝温度仍有小幅上升,电话随访结果显示,所有患者疗效均能持续6个月以上,1年内复发率为9.42%,2年复发率37.4%,代偿性多汗发生率7.89%,无气胸、血胸、截瘫等并发症发生。结论 CT引导下胸交感神经调制可安全、有效地治疗腋下多汗症。

Objective To observe the effect of CT-guided thoracic sympathetic nerve modulation in the treatment of axillary hyperhidrosis. Methods From March 2011 to March 2013,28 cases with axillary hyperhidrosis received CT-guided thoracic sympathetic nerve modulation in the First Hospital of Jiaxing. The puncture of thoracic sympathetic nerve was guided by CT through the gapof T4/5 ,until the needle tip arrive at the top of the fifth ribs head. 1% lidocaine 2 ml（ mixed with Iohexol injection） was injected. If the lidocaine was founded to spread just in front of the fifth ribs head,the anterior parietal regions outside of parietal at the level of the fourth or fifth thoracic vertebra, Oximetry-derived perfusion index of little finger and the temperature of axillarys began to ascend（ about 20 min later） ,2.5 ml of absolute alcohol was injected on both sides of axilla to modulate the thoracic sympathetic nerve. Results The needle punctured at right position guided by CT ;5 min after anesthesic was injected, the Oximetry-derived perfusion index of the little finger and the temperature of axillarys raised （6.69 ± 1.58 ） times and （ 1.78 ± 0.26）℃ in average, respectively. After the injection of absolute alcohol, the axillary hyperhidrosis was cured in all 28 patients within 6 months, and the recurrence rate within one and two year was 9.24% and 37.4%, compasation hyperhidrosis was 7.89%. There were no pneumothorax, hemothorax, paraplegia and other complications. Conclusion Thoracic sympathetic nerve modulation guided by CT can be used for treating axillary hyperhidrosis safely and effectively.