单孔法胸腔镜下T_3/T_4胸交感神经链切断术治疗原发性手汗症27例的效果观察

Efficiency observation of single-hole thoracoscopic sympathectomy with T_3/T_4 thoracic nerve chain on treatment of 27 patients with primary palmar hyperhidrosis

目的探讨单孔法胸腔镜下T_3/T_4胸交感神经链切断术治疗原发性手汗症的效果。方法选取单孔法胸腔镜下行T_3或T_4胸交感神经链切断术治疗原发性手汗症27例。分别记录患者交感神经链切断术前、术后掌温变化情况及治疗情况。结果 27例患者手术均获得成功,无1例中转开胸。术后随访1～12月,平均6月,无复发病例。手术时间(50. 0±9. 1) min,术中出血量(5. 0±2. 5) m L,术后掌温升高(1. 3±0. 2)℃,住院时间(5. 7±2. 3) d。平均住院费用9 800元。1例患者术后出现气胸,3例患者术后5～6 d出现颜面部、前胸部代偿性多汗,7～14 d后均能缓解。无血胸、心脏骤停、Horner综合征等并发症发生。手术治疗有效率100. 0%,腋窝和足底多汗症状得到改善。结论单孔法胸腔镜下T_3/T_4胸交感神经链切断术治疗原发性手汗症安全、有效。

Objective To investigate the clinical efficiency of single-hole thoracoscopic sympathectomy with T 3/T 4 thoracic nerve chain in the treatment of patients with primary palmar hyperhidrosis. Methods A total of 27 patients with primary palmar hyperhidrosis were treated by single-hole thoracoscopic sympathectomy with T 3/T 4 thoracic nerve chain. The change of palmar temperature were recorded before and after sympathectomy, and the therapeutic condition was compared. Results All the 27 patients finished surgery successfully, and no one was converted to thoracotomy. All the patients were followed up for 1 to 12 months, with an average of 6 months, and no recurrence case occurred. The operation time was (50.0±9.1) minutes, the amount of intra-operative bleeding was (5.0±2.5) mL, the temperature of palm increased (1.3±0.2)℃, and the hospital stay was (5.7±2.3) days. The average hospitalization cost was 9 800 RMB. One patient had pneumothorax after operation, 3 patients had compensatory hyperhidrosis of the face and anterior chest within 5 to 6 days after operation, and these complications were alleviated after 7~14 days. No complications such as hemothorax, cardiac arrest and Horner syndrome occurred. The effective rate of surgical treatment was 100.0%. The symptoms of axillary and plantar hyperhidrosis were improved. Conclusion Single-hole thoracoscopic sympathectomy with T 3/T 4 thoracic nerve chain is effective and safe in the treatment of patients with primary palmar hyperhidrosis.