单孔胸腔镜下R_(4)联合R_(3)、R_(4)侧支交感神经链切断术治疗原发性手汗症临床疗效

Clinical effect of uniportal thoracoscope R4 combined with R3 and R4 collateral sympathetic chain amputation in the treatment of primary palmar hyperhidrosis

目的探讨单孔法胸腔镜下R_(4)联合R_(3)、R_(4)侧支交感神经链切断术治疗原发性手汗症的临床疗效。方法选取自2013年10月至2021年5月收治的164例原发性手汗症患者为研究对象。所有患者均于R4水平切断交感神经链,同时,切断R_(3)、R_(4)侧支(旁路传导纤维),观察其治疗效果。结果所有患者术后双侧手掌即刻红润,呈温暖干燥状。术后2 d,手掌、腋下多汗症状均消失,足汗症状较术前明显减轻。所有患者均完成12个月的随访,且手汗症状均得到改善。术后转移性出汗118例,其中,Ⅰ级93例,Ⅱ级25例。手术满意度调查结果显示,非常满意162例,满意2例。结论单孔胸腔镜下R4联合R3、R4侧支交感神经链切断术治疗原发性手汗症疗效确切,患者满意度较高。

Objective To investigate the clinical effect of uniportal thoracoscope R4 combined with R3 and R4 collateral sympathetic chain amputation in the treatment of primary palmar hyperhidrosis.Methods A total of 164 patients with primary palmar hyperhidrosis admitted from October 2013 to May 2021 were selected as the study objects.In all patients,the sympathetic nerve chain was cut at R4 level,and the collateral branches of R3 and R4(bypass fibers)were cut at the same time,and the therapeutic effect was observed.Results In all patients,both palms were immediately red,warm and dry after surgery.Two days after the operation,the symptoms of palm and armpit oversweating disappeared,and the symptoms of foot oversweating were significantly reduced.All patients completed 12 months of follow-up,and hand oversweating symptoms improved.There were 118 cases of metastatic sweating,of which 93 were gradeⅠand 25 were gradeⅡ.The results of operation satisfaction survey showed that 162 cases were very satisfied and 2 cases were satisfied.Conclusion Uniportal thoracoscope R4 combined with R3 and R4 collateral sympathetic chain amputation is effective in the treatment of primary palmar hyperhidrosis,and the patient’s satisfaction is high.