胸腔镜下交感神经切断术治疗手汗症10年meta分析

Thoracoscopic sympathectomy for palmar hyperhidrosis： a meta-analysis of studies published during the past decade

目的 系统评价胸腔镜下交感神经切断术（video-assisted thoracoscopic sympathectomy,VTS）在手汗症治疗中的作用,分析不同交感神经节段手术间疗效的差异.方法 通过PubMed数据库搜索过去10年VTS治疗手汗症相关研究,选取其中涉及不同节段手术效果对比的文献报道并提取相关数据,以术后代偿性出汗作为主要评价指标,运用RevMan 5.2软件系统分析不同节段手术间效果差异.结果 经过筛选,纳入11篇随机对照实验（randomized controlled trial,RCT）,共1 413例患者,均行双侧VTS手术.单节段与多节段手术有效率间差异无统计学意义（97.7％对98.8％,P＜0.01）,纳入文献中单节段组术后代偿性出汗发生率均低于/等于多节段组.Meta分析结果显示,单独对单节段手术进行对比,T2、T3组术后代偿性出汗发生率与其他节段手术差异无统计学意义[T2节段对其他节段,RR=1.11,95％ CI（0.99,1.24）;T3节段对其他节段,RR =0.99,95％ CI（0.89,1.11）],T4节段术后代偿性出汗发生率明显低于其他节段手术[RR =0.67,95％ CI（0.57,0.79）];在单节段手术组内对比,低节段手术较高节段手术术后代偿性出汗发生率明显减低[RR =0.75,95％ CI（0.68,0.84）].结论 低节段限制性手术能明显降低术后代偿性出汗发生率,其中T4节段VTS具有最佳手术效果.

Objective To evaluate video-assisted thoracoscopic sympathectomy（VTS） for the treatment of palmar hyperhidrosis（PH）,and to analyze curative efficacies for surgeries on different sympathetic segments.Methods Medline search was done on PubMed and data of randomized controlled trials（RCTs） about comparisons of surgeries on different segments over the past decade were collected.According to the inclusion criterion,relevant articles were screened.Then we extracted data,assessed trail quality,and performed Meta-analysis by using RevMan 5.2 with postoperative compensatory hyperhidrosis（CH） as the main evaluation index.Results A total of 11 RCTs involving 1 413 patients were included,among which all patients underwent bilateral VTS.Ef cacious rates were similar between multiple and single ganglia sympathectomy（97.7% vs 98.8%,P 〈0.01）.However,single-ganglia group showed a lower risk of CH compared to multiple-ganglia group.Meta-analysis suggested that,in the subgroups of the single-ganglia VTS,no significant difference was found between T2/T3 and other segments in the risk of CH [T2 segment vs other segments,RR =1.11,95 % CI（0.99,1.24） ; T3 segment vs other segments,RR =0.99,95% CI（0.89,1.11）].The risk of CH was significantly lower in T4 sympathectomy than in other segments [RR =0.67,95% CI（0.57,0.79）].By comparison of T2,T3 and T4 sympathectomy,we found that low segment had a lower risk of CH than high segment[RR =0.75,95% CI（0.68,0.84）].Conclusion Single-ganglia and low segment sympathectomy can significantly reduce the incidence of CH,and T4 is supposed to be the best segment for the treatment of PH.