改良福勒(Fowler)体位与传统侧卧位单孔胸腔镜胸交感神经链切断术的对比研究

Modified Fowler’s Position Versus Lateral Decubitus Position for Uniportal Video-assisted Thoracoscopic Sympathectomy

目的探讨改良福勒(Fowler)体位在单孔胸腔镜胸交感神经链切断术中应用的可行性和安全性。方法回顾性分析我院2018年1月~2020年10月82例手汗症的临床资料,改良福勒体位40例,传统侧卧位42例。改良福勒体位为在标准福勒体位基础上,双臂外展至90°~120°暴露双侧腋窝,先行右侧手术,再行左侧手术;传统侧卧位先左侧卧位行右侧手术,再改为右侧卧位行左侧手术。比较2组手术时间、麻醉时间、单侧手术双肺停止通气时间、术后疼痛评分、术后住院时间以及术后代偿性多汗等并发症。结果2组手术均在单孔胸腔镜下顺利完成。与传统侧卧位组比较,改良福勒体位组手术时间短[(19.3±2.1)min vs.(33.6±2.6)min,t=-27.266,P=0.000],麻醉时间短[(30.1±2.2)min vs.(43.7±3.3)min,t=-22.258,P=0.000]。2组单侧手术双肺停止通气时间、术后疼痛评分、术后住院时间、术后代偿性多汗等并发症差异均无统计学意义(P>0.05)。结论与传统侧卧位相比,改良福勒体位行胸交感神经链切断术能够避免中转体位,且疗效相当,是安全可行的。

Objective To compare the safety and usefulness of modified Fowler’s position(MFP)and lateral decubitus position(LDP)for uniportal video-assisted thoracoscopic sympathectomy(UVATS)in the treatment of primary palmar hyperhidrosis(PPH).Methods A retrospective study was performed on 82 patients with PPH who underwent UVATS from January 2018 to October 2020,including 40 patients with MFP and 42 patients with LDP.The MFP is based on the standard Fowler’s position,with the arms abducted to 90°-120°so as to expose the bilateral axillary.The right side UVATS was performed ahead of the contralateral surgery.In the LDP group,the right side UVATS was applied through left LDP firstly,and vice versa.The operation time,anesthesia time,apnea period of both lungs during unilateral surgery,postoperative pain intensity,postoperative hospital stay and grade of compensatory sweating were compared between the two groups.Results All the operations were successfully performed with no perioperative complications.As compared with the LDP group,the MFP group had shorter operating time[(19.3±2.1)min vs.(33.6±2.6)min,t=-27.266,P=0.000]and shorter anesthesia time[(30.1±2.2)min vs.(43.7±3.3)min,t=-22.258,P=0.000].There was no significant differences on apnea period of both lungs during unilateral surgery,postoperative pain score,postoperative hospital stay,or grade of compensatory sweating between the two groups(P>0.05).ConclusionsCompared with LDP,UVATS through MFP can avoid transferring positions while performing bilateral surgery.UVATS through MFP is highly effective and easy to perform for PPH.