不同节段胸交感神经切断术对手汗症患者术后影响的系统评价与Meta分析

Postoperative effects of different thoracoscopic sympathectomy on palmar hyperhidrosis patients:A systematic review and meta-analysis

目的评价不同节段胸交感神经切断术对手汗症患者术后影响的差异。方法计算机检索万方数据库、中国学术期刊全文数据库(CNKI)、中文科技期刊数据库、中国生物医学文献数据库(CBM)、Pub Med、EMbase及Cochrane Library,检索时间从建库至2016年3月。收集胸交感神经切除治疗手汗症的临床研究。评价纳入研究的质量。采用Rev Man5.3软件对收集的资料进行Meta分析。结果最终纳入15项研究,共2 542例患者。纳入的研究包括9篇随机对照研究,3篇队列研究,3篇回顾性研究。Meta分析结果显示,T3交感神经切除患者术后代偿性出汗发生率与T2交感神经切除术患者差异有统计学意义[OR=4.88,95%CI(1.88,12.68),P=0.001];与T2~4节段神经切除患者比较,T3~4节段切除患者术后代偿性出汗发生率降低,且差异有统计学意义[OR=5.13,95%CI(2.91,9.02),P<0.000 01];同时与T3节段比较,T4节段患者术后代偿性出汗及手部干燥发生率降低,且差异有统计学意义[OR=2.91,95%CI(2.06,4.12),P<0.000 01;OR=14.60,95%CI(3.06,69.63),P=0.000 8]。结论胸4节段交感神经切断术能显著降低患者术后代偿性出汗及手部干燥的发生率,提高患者术后生活质量,具有最佳的手术效果。

Objective To evaluate the postoperative effects of different thoracoscopic sympathectomy on palmar hyperhidrosis patients. Methods We searched the Wanfang Database, CNKI, Weipu, CBM, PubMed, Cochrane Library （from inception to March 2016） to identify studies about thoracoscopic sympathectomy on palmar hyperhidrosis patients. Quality of the included studies was evaluated. The meta-analysis was performed by RevMan5.3 software. Results A total of 15 studies （9 randomized controlled trials, 3 cohort studies, and 3 retrospective studies） involving 2 542 patients were included. The result of meta-analysis suggested that there was statistical difference in postoperative compensatory hyperhidrosis （OR=4.88, 95% CI 1.88 to 12.68,P=0.001） between T2 sympathectomy and T3 sympathectom. Compared with T2-4 sympathectomy patients, the risk of postoperative compensatory hyperhidrosis in T2-4 sympathectomy group was significantly lower （OR=5.13, 95% CI 2.91 to 9.02,P〈0.000 01）. Compared with T3 sympathectomy group, the risk of postoperative compensatory hyperhidrosis and hand dry in the T4 sympathectomy group was significantly lower （OR=2.91, 95% CI 2.06 to 4.12,P〈0.000 01;OR=14.60, 95% CI 3.06 to 69.63,P=0.000 8）, respectively. Conclusion The rate of postoperative compensatory hyperhidrosis or hand dry is lower on T4 sympathectomy patients and supposed to be the best segment for the treatment of palmar hyperhidrosis patients.