胸腔镜下R4与R3+R4胸交感神经切断术治疗手足多汗症近远期疗效的单中心回顾性队列研究

Short-and long-term effects of R4 versus R3+R4 endoscopic thoracic sympathicotomy for acrohyperhidrosis:A retrospective cohort study in a single center

目的对比胸腔镜下R4与R3+R4胸交感神经切断术(endoscopic thoracic sympathicotomy,ETS)治疗手足多汗症的近远期疗效。方法回顾性分析2014年4月—2021年4月于甘肃省人民医院胸外科行手术治疗手足多汗症患者的临床资料。根据ETS方法将患者分为两组:R4组和R3+R4组。比较两组患者近、远期疗效。结果共纳入155例患者,R4组60例患者,其中男23例、女37例,平均年龄(22.55±2.74)岁;R3+R4组95例患者,其中男40例、女55例,平均年龄(23.14±3.65)岁。两组患者在性别、年龄和阳性家族史等基线指标方面差异无统计学意义(P>0.05)。R4组总手术时间为(38.67±5.20)min,R3+R4组为(40.05±5.18)min;R4组术中出血量为(7.25±3.25)mL,R3+R4组为(7.95±3.90)mL;R4组术后住院时间为(1.28±0.52)d,R3+R4组为(1.38±0.57)d,以上指标两组差异均无统计学意义(P>0.05)。术后两组患者的手汗症症状均显著缓解,R3+R4组完全缓解率优于R4组(98.0%vs.93.3%),但差异无统计学意义(P=0.358)。R3+R4组在足汗症症状缓解情况、患者满意度和术后6个月生活质量指数方面优于R4组,差异有统计学意义(P<0.05)。术后12个月R3+R4组代偿性多汗发生率高于R4组(72.6%vs.70.0%),但差异无统计学意义(P=0.867)。结论R4与R3+R4 ETS治疗手足多汗症的围手术期疗效相近,但R3+R4 ETS的手汗症和足汗症症状缓解率更高,患者术后生活质量更高。R3+R4 ETS是治疗手足多汗症的一种可靠选择。但这种手术方式可能会增加术后代偿性多汗的风险。

Objective To compare the short-and long-term effects of R4 versus R3+R4 endoscopic thoracic sympathicotomy(ETS)for acrohyperhidrosis.Methods We retrospectively analyzed the clinical data of patients with acrohyperhidrosis admitted to the Department of Thoracic Surgery of Gansu Provincial Hospital for surgical treatment from April 2014 to April 2021.The patients were divided into two groups according to the methods of ETS,including a R4 group and a R3+R4 group.Perioperative clinical data and postoperative follow-up data were collected to compare the short-and long-term outcomes of the two groups.Results A total of 155 eligible patients were included.There were 60 patients in the R4 group,including 23 males and 37 females,with a mean age of 22.55±2.74 years.There were 95 patients in the R3+R4 group,including 40 males and 55 females,with a mean age of 23.14±3.65 years.There were no statistical differences between the two groups in terms of baseline indicators such as gender,age and positive family history(P>0.05).Total operative time was 38.67±5.20 min in the R4 group and 40.05±5.18 min in the R3+R4 group;intraoperative bleeding was 7.25±3.25 mL in the R4 group and 7.95±3.90 mL in the R3+R4 group;postoperative hospital stay was 1.28±0.52 d in the R4 group and 1.38±0.57 d in the R3+R4 group,the differences between the two groups in the above indicators were not statistically significant(P>0.05).Postoperative hand hyperhidrosis symptoms were significantly relieved in both groups,and the complete remission rate was better in the R3+R4 group than that in the R4 group(98.0%vs.93.3%),but the difference was not statistically significant(P=0.358).The R3+R4 group was superior to the R4 group in terms of the relief of plantar hyperhidrosis symptoms,patient satisfaction and quality of life index at 6 months postoperatively(P<0.05).There was no statistical difference in the overall incidence of compensatory hyperhidrosis at 12 months postoperatively between the two groups(P=0.867),but the incidence of compensatory hyperhidrosis was higher in the R3+R4 group than that in the R4 group(72.6%vs.70.0%).Conclusion The perioperative outcomes of R4 and R3+R4 ETS are similar,but R3+R4 ETS has a higher rate of symptomatic relief of acrohyperhidrosis,and patients have a better postoperative quality of life.R3+R4 ETS is a reliable option for the treatment of acrohyperhidrosis.However,patients need to be informed that this procedure may increase the risk of compensatory hyperhidrosis.