243例原发性手汗症患者胸腔镜下胸交感神经切断术后生活质量分析

Quality of life in 243 patients with primary palmar hyperhidrosis after endoscopic thoracic sympathicotomy

目的评估原发性手汗症(primary palmar hyperhidrosis,PPH)患者胸腔镜下胸交感神经切断术(endoscopic thoracic sympathicotomy,ETS)术后生活质量(quality of life,QOL)并分析其影响因素。方法纳入2017年1月—2018年1月福建医科大学附属第一医院成功接受ETS(仅T3水平胸交感神经切断)治疗的PPH患者243例,其中男118例、女125例,平均年龄(21.99±6.31)岁。采用世界卫生组织生活质量测定量表评估ETS前后患者的QOL。通过建立性别、年龄、体重指数、代偿性多汗(compensatory hyperhidrosis,CH)、手掌干燥的线性回归模型,研究QOL变化与各因素间的关系。结果 ETS术后QOL总分高于术前(63.01±4.58 vs. 48.11±1.95,P<0.05)。术后合并CH与阴性组比较,QOL总分改变情况降低4.662。CH的程度每升高1级,QOL总分改变情况降低3.449。术后合并胸部CH、背部CH与阴性组比较,QOL总分改变情况均降低,其中随着CH的严重程度每升高1级,QOL总分改变情况分别降低1.804、2.400。结论 ETS不仅能改善手掌异常多汗症状,而且能显著提高QOL。重度胸背部CH是影响患者QOL的重要因素。

Objective To evaluate the quality of life(QOL) in patients with primary palmar hyperhidrosis(PPH) after endoscopic thoracic sympathicotomy(ETS) and analyze the influencing factors. Methods A total of 243 patients(118 males and 125 females, with an average age of 21.99±6.31 years) with PPH who were successfully treated with ETS(only T3 level thoracic sympathicotomy) in our hospital from January 2017 to January 2018 were enrolled, and the World Health Organization Quality of Life Scale Brief Version(WHOQOL-BREF) was used to assess the QOL scores before and after ETS. By establishing a linear regression model of gender, age, body mass index, compensatory hyperhidrosis(CH)and palm dryness, and the relationship between the changes of the QOL scores and various factors was studied. Results The total QOL score after surgery was higher than that before surgery(63.01±4.58 vs. 48.11±1.95, P<0.05). Compared with the negative group of CH, the QOL score decreased by 4.662 in the postoperative CH patients. For every grade of CH severity increasing, the QOL score decreased by 3.449. Compared with the negative group, the QOL scores decreased by 1.804 and2.400 respectively for every grade of CH severity increasing in the patients with postoperative chest and back CH.Conclusion ETS can not only improve the symptoms of abnormal palmar hyperhidrosis, but also significantly improve the QOL. Severe chest and back CH is an important factor affecting the QOL of patients.