胸腔镜治疗手汗症:先左侧还是先右侧?

Bilateral endoscopic thoracic sympathectomy in treatment of palmar hyperhidrosis:left first or right first?

目的探讨左侧或者右侧先行胸腔镜下行胸交感神经切断术(ETS)对血流动力学及治疗效果的影响。方法纳入成功完成ETS治疗手汗症的108例患者,按随机数字表法分为L组和R组,每组54例。L组先行左侧ETS,R组先行右侧ETS,分析比较两组患者围术期血流动力学指标变化情况,并通过电话问卷方式对患者进行随访,通过患者生活质量对比两种手术方式的疗效差异。结果所有患者手术顺利,术后手汗症均得到显著改善,两组患者围术期血压、心率、心电图矫正QT间期(QTc)、心率变异性(HRV)各项指标无统计学差异。平均随访(12±2)个月,随访过程中,两组患者生活质量评分比较无统计学差异,未发现手汗症复发、严重心率失常、死亡的病例。结论胸腔镜治疗手汗症是安全、有效、微创的方法。

Objective To investigate the sequence of performing bilateral endoscopic thoracic sympathectomy（ETS） in treatment of palmar hyperhidrosis.Methods One hundred and eight patients with palmar hyperhidrosis undergoing bilateral ETS in our hospital were enrolled in this study.Patients were randomly divided into two groups：54 patients received left ETS first,followed by the right（group L）,and another 54 patients received right ETS first,followed by the left（n=54）.The perioperative hemodynamic changes were compared between the two groups;and the clinic effects and the quality of life of patients were evaluated one year after the operation.Results The bilateral ETS were performed smoothly,and the clinical effects were satisfactory in both groups.There were no significant differences in perioperative blood pressure,heart rate,corrected Q waves and T waves interval（QTc） in ECG,and heart rate variability（HRV） between the two groups.The patients were followed up period for 12±2 months;no differences were found in quality of life between the two groups and also no disease relapse,severe arrhythmia and death were reported.Conclusion ETS is a safe,effective,minimally invasive treatment for palmar hyperhidrosis.The sequence of performing left or right ETS first makes no significant difference on the clinical outcomes.