单孔胸腔镜下双侧胸交感神经链切断术治疗手汗症的临床分析

Single-port thoracoscopic lateral thoracic sympathectomy for the treatment of palmar hyperhidrosis

目的观察单孔腔镜下双侧胸交感神经切断术治疗手汗症的临床效果。方法选取我院收治的42例手汗症患者为观察对象,行全身麻醉,单腔气管插管,于腋中线至腋后线之间第4肋间取一切口,经套管置入电视胸腔镜,术中于第3、4肋骨表面电灼切断交感神经链,术后随访3个月,观察治疗效果。结果 42例患者均顺利完成手术,手术时间25~55(30.5±5.2)min,住院时间(3.8±1.2)d。术后患者手汗症状完全消失,手术有效率为100%。合并足底、面部及腋窝多汗者症状均消失。术后发生少量气胸2例,胸腔穿刺抽气后恢复正常,无霍纳综合征发生。术后随访3个月无复发者,出现代偿性多汗者9例,其中轻度5例,中度4例,无重度者。结论单孔电视胸腔镜下交感神经切断术治疗手汗症效果显著,且具有微创、安全的特点,值得推广应用。

Objective To observe the clinical efficacy of single-port thoracoscopic thoracic sympathectomy for the treatment of palmar hyperhidrosis.Methods Forty-two patients with palmar hyperhidrosis in our hospital were enrolled.General anesthesia and single-lumen endotracheal intubation were performed.A incision was made at the fourth intercostal space between midaxillary line and posterior axillary line.Video thoracoscope was inserted through the Trocor.The sympathetic chain resection was conducted using electrocautery on the surface of the third and forth ribs.Three-month follow-up was performed after operation to assess the therapeutic efficacy.Results The operation was completed successfully in the 42 patients.The duration for lateral operation and the hospital stay were 25 - 55 （30.5 ± 5.2） min and （3.8 ±1.2） d respectively.Hyperhidrosis was completely occurred in both groups in all patients after operation,the operative effectiveness rate was 100%.The symptom vanished completely in 2 cases complicated with plantar hyperhidrosis and in the cases with facial and axillary hyperhidrosis.Two cases suffered from mild pneumothorax after operation,but recovered after thoracentesis.No Horner＇ s syndrome occurred.During 3-month of postoperative follow-up,on recurrence was found in any cases,compensated hyperhidrosis in 9 cases including 5 cases with mild,4 cases with moderate.Conclusion Single-port thoracoscopic lateral thoracic sympathectomy can obtain a significant efficacy for palmar hyperhidrosis,is minimally invasive and safe,and is worthy of promotion and application.