3mm胸腔镜联合免trocar电凝钩经乳晕切口治疗男性手汗症

The 3-mm Thoracoscope Combined With Trocar-free Electrocoagulation Hook for Treatment of Male Palmar Hyperhidrosis Through Periareolar Incision

目的探讨3 mm针式胸腔镜联合2 mm免trocar电凝钩经乳晕切口行胸交感神经链切断术治疗男性原发性手汗症(primary hyperhidrosis,PH)的可行性。方法 2016年6月～2018年2月对18例男性PH,3 mm胸腔镜经乳晕外侧缘做一3 mm切口,2 mm免trocar电凝钩经乳晕内侧缘行T_3、T_4胸交感神经链切断术。结果 18例均顺利完成手术,手术时间20～58 min,平均29. 4 min。出血量2～5 ml,平均2. 3 ml。术后住院1～3 d,平均1. 3 d。术后手汗症状均消失,12例轻度代偿性出汗,3例气胸,2例少量胸腔积液,13例切口感觉异常,5例切口轻度疼痛。18例术后随访1～19个月,平均11. 5月,均达到有效标准,未出现中重度代偿性出汗,手术切口甲级愈合,愈合后较隐蔽。结论 3 mm针式胸腔镜联合2 mm免trocar电凝钩经乳晕切口行胸交感神经链切断术治疗男性PH效果良好,安全,手术切口隐蔽,符合微创及美学要求,具有可行性。

Objective To explore the feasibility of 3-mm needle-like thoracoscope combined with 2-mm trocar-free electrocoagulation hook through the periareolar incision to perform the thoracic sympathectomy for the treatment of male palmar hyperhidrosis.Methods From June 2016 to February 2018,18 cases of male primary palmar hyperhidrosis were treated by 3-mm thoracoscope with a 3-mm incision through the lateral edge of areola and 2-mm trocar-free electrocoagulation hook through the medial edge of areola for T3 and T4 thoracic sympathectomy.Results All the 18 patients were given operation successfully.The operative time was 20-58 min with an average of 29.4 min.The amount of bleeding was 2-5 ml with an average of 2.3 ml.The postoperative hospital stay was 1-3 d with an average of 1.3 d.After operation,the palmar hyperhidrosis disappeared.There were 12 cases of mild compensatory sweating,3 cases of pneumothorax,2 cases of small pleural effusion,13 cases of abnormal incision sensation and 5 cases of slight incision pain.All the cases were followed up for 1-19 months with an average of 11.5 months.There was no moderate or severe compensatory sweating.The healing of the surgical incision was graded A.The incision was concealed after healing.Conclusions The 3-mm needle-like thoracoscope combined with 2-mm trocar-free electrocoagulation hook through the periareolar incision to perform the thoracic sympathectomy for the treatment of male palmar hyperhidrosis is effective,safe,and feasible.The surgical incision is concealed,in line with minimally invasive and aesthetic requirements.