日间手术模式下胸腔镜胸交感神经切断术治疗手汗症的安全性和可行性

Safety and feasibility of thoracic sympathectomy in the treatment of primary palmar hyperhidrosis based on ambulatory surgery

目的探讨日间手术模式下胸腔镜胸交感神经切断术治疗手汗症的临床安全性和可行性。方法回顾性分析2017年1月—2021年4月于云南省第一人民医院胸外科行胸腔镜胸交感神经切断术74例患者的临床资料,其中男35例、女39例,年龄12~38(21.32±4.13)岁。根据治疗方式不同将患者分为两组:对照组34例(行传统手术),观察组40例(行日间手术)。比较两组临床效果。结果所有患者均无术中大出血、中转开胸、术后并发气胸和重症肺炎。两组总住院费用、手术时间、麻醉时间、术后等待时间等方面差异无统计学意义(P>0.05),观察组术中出血量少于对照组(P<0.05)。观察组术后恢复进食和下床活动时间、电解质紊乱发生率等方面短于或小于对照组(P<0.05),白细胞计数、中性粒细胞计数、术后24 h脉搏血氧饱和度波动峰值等方面差异无统计学意义(P>0.05)。结论基于优化后的诊疗模式,喉罩通气下胸腔镜胸交感神经切断日间手术是安全、可行的,可尝试在胸外科推广。

Objective To investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery.Methods A retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People’s Hospital of Yunnan Province from January 2017 to April 2021 was performed,including 35 males and 39 females aged 12-38(21.32±4.13)years.Patients were divided into two groups according to different treatments.There were 34 patients in a control group(adopting traditional surgery),and 40 patients in an observation group(adopting ambulatory surgery).The clinical effects of the two groups were compared.Results No massive bleeding,conversion to thoracotomy,postoperative pneumothorax or severe pneumonia occured in all patients.Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost,operation time,anesthesia time or postoperative waiting time(P>0.05).The amount of intraoperative blood loss in the observation group was less than that in the control group(P<0.05).The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group(P<0.05).There was no statistical difference in white blood count,neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups(P>0.05).Conclusion Based on the optimized diagnosis and treatment model,thoracoscopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery,is feasible and worth popularizing in thoracic surgery.