单孔胸腔镜下交感神经链切断术治疗手汗症的临床疗效及其与手掌温度上升最大值的关系

Efficacy of single-port thoracoscopic sympathectomy for treatment of hand sweat syndrome and its relationship with palm temperature detection

目的探究单孔胸腔镜下交感神经链切断术治疗手汗症的临床疗效及其与手掌温度上升最大值的关系。方法选取2016年4月至2021年1月于安徽省宿州市立医院进行治疗的手汗症患者80例为研究对象,进行回顾性分析,所有患者均行单孔胸腔镜T_(4)交感神经链切断术治疗。观察患者术后治疗效果及交感神经链切断前,切断后5、10、15及20 min的手掌温度最大值(T_(max)),分析不同掌温T_(max)值患者T_(4)切断术后的手汗症情况。结果80例患者经治疗后,治疗的有效率为98.75%(79/80);随访发现,80例患者手掌干燥者57例(71.25%),微潮湿者23例(28.75%),术后并发转移性出汗8例(10.00%),其中胸背部出汗3例,臀部及大腿内侧出汗5例。重复测量结果显示,80例(160只手)手汗症患者,交感神经切断前,切断后5、10、15及20 min的左右手掌温度变化差异均无统计学意义(P>0.05);但交感神经切断前后两手不同时点掌温变化差异有统计学意义(P<0.05)。术中掌温T_(max)升高<1℃者手掌干燥者占比为31.25%,明显低于1~2℃(81.48%)和≥2℃的患者(70.27%),差异有统计学意义(P<0.05)。结论单孔胸腔镜下T_(4)交感神经链切断术治疗手汗症创伤小、安全性高且疗效显著。同时其术后疗效与术中掌温变化可能存在一定相关性,其中掌温上升不明显者术后疗效不佳的概率偏高。

Objective To explore the efficacy of single-port thoracoscopic sympathectomy for treatment of hand sweat syndrome and its relationship with palm temperature detection.Methods Eighty patients with hand sweat syndrome who were treated in Suzhou Municipal Hospital of Anhui Province from April 2016 to January 2021 were the research objects,and they were retrospectively analyzed.All patients were treated with single-port thoracoscopic T_(4) segment sympathectomy.The postoperative treatment effect and the maximum temperature rise(T_(max))of the palm before and 5,10,15 and 20 min after the sympathetic chain severing were observed,and the hand sweat of different T_(max) values in patients with T_(4) resection were analyzed.Results After 80 patients were treated,the effective rate of treatment was 98.75%(79/80);follow-up found that 80 patients had dry palms accounted for 57 cases(71.25%),slightly humid accounted for 23 cases(28.75%),postoperative complicated with metastatic sweating in 8 cases(10.00%),including 3 cases of chest and back sweating,5 cases of buttocks and inner thigh sweating.Repeated measurement results showed that in 80 patients(160 hands)with hand sweat syndrome,there was no statistically significant difference in temperature changes between the left and right palms before and 5,10,15 and 20 minutes after the sympathetic nerve transection(P>0.05);but the difference in palm temperature of the two hands at different time points before and after sympathetic nerve transection was statistically significant(P<0.05).Intraoperative palm temperature T_(max) increased<1℃accounted for 31.25%of patients with dry palms,which was significantly lower than that of patients with 1-2℃(81.48%)and≥2℃(70.27%),and the difference was statistically significant(P<0.05).Conclusion Single-port thoracoscopic T_(4)sympathetic chain amputation is less invasive,more safe and more effective.At the same time,there may be a certain correlation between the postoperative efficacy and the intraoperative changes of palmar temperature.