胸腔镜下T_(3)和T_(4)不同节段双侧胸交感神经切断术治疗原发性手汗症的疗效比较

Comparison of the efficacy of bilateral thoracic sympathectomy at different segments of T_(3) and T_(4) under thoracoscopy for treatment of primary palmar hyperhidrosis

目的比较胸腔镜下T_(3)和T_(4)不同节段双侧胸交感神经切断术治疗原发性手汗症(PPH)的疗效。方法回顾性收集2017年1月至2023年3月于首都医科大学宣武医院胸外科接受胸腔镜下胸交感神经切断术治疗的125例PPH患者的临床资料。根据切断胸交感神经节段的不同,将患者分为T_(3)组(60例)和T_(4)组(65例)。T_(3)组接受胸腔镜下T_(3)节段双侧胸交感神经切断术,T_(4)组接受胸腔镜下T_(4)节段双侧胸交感神经切断术。比较两组临床资料、术后不同时间点PPH复发率和代偿性出汗(CH)发生情况以及术后12个月时患者对手术的满意度。结果两组年龄、性别、家族史、症状持续时间、PPH分级、手术时间、术后并发症和住院时间比较差异无统计学意义(P>0.05),两组手术有效率均为100%。术后1个月、6个月、12个月时,两组PPH复发率比较差异无统计学意义(P>0.05)。术后1个月时,两组CH发生率和CH严重程度比较差异无统计学意义(P>0.05)。术后6个月、12个月时,T_(3)组CH发生率显著高于T_(4)组(P<0.05),两组CH严重程度比较差异有统计学意义(P<0.05)。两组术后12个月时患者对手术的满意度比较差异无统计学意义(P>0.05)。结论胸腔镜下T_(3)和T_(4)节段双侧胸交感神经切断术治疗PPH均显示出良好的效果。与T_(4)节段双侧胸交感神经切断术相比,T_(3)节段双侧胸交感神经切断术后6个月、12个月时的CH发生率较高。

Objective To compare the efficacy of bilateral thoracic sympathectomy at different segments of T_(3) and T_(4) under thoracoscopy for treatment of primary palmar hyperhidrosis(PPH).Methods The clinical data of 125 patients with PPH who underwent thoracic sympathectomy under thoracoscopy in the Department of Thoracic Surgery of Xuanwu Hospital Capital Medical University from January 2017 to March 2023 were retrospectively collected.The patients were divided into T_(3) group(60 cases)and T_(4) group(65 cases)according to thoracic sympathectomy at different segments.The T_(3) group underwent bilateral thoracic sympathectomy at segment of T_(3) under thoracoscopy,and the T_(4) group underwent bilateral thoracic sympathectomy at segment of T_(4) under thoracoscopy.The clinical data,the recurrence rate of PPH and the occurrence of compensatory hyperhidrosis(CH)at different time points after the operation,and the patients'satisfaction with the operation at 12 months after the operation were compared between the two groups.Results There were no statistically significant differences in age,gender,family history,duration of symptoms,PPH grade,duration of surgery,postoperative complications and length of hospital stay between the two groups(P>0.05),and the surgical effectiveness rate was 100%in both groups.At 1 month,6 months and 12 months after surgery,there were no significant differences in the recurrence rates of PPH between the two groups(P>0.05).At 1 month after surgery,there were no significant differences in the incidence of CH and the severity of CH between the two groups(P>0.05).At 6 months and 12 months after surgery,the incidence of CH in the T_(3) group was significantly higher than that in the T_(4) group(P<0.05),and there was significant difference in the severity of CH between the two groups(P<0.05).At 12 months after surgery,there was no significant difference in the patients'satisfaction with the operation between the two groups(P>0.05).Conclusion Both bilateral thoracic sympathectomy at segment of T_(3) under thoracoscopy and bilateral thoracic sympathectomy at segment of T_(4) under thoracoscopy have good efficacy in the treatment of PPH.Compared with bilateral thoracic sympathectomy at segment of T_(4),bilateral thoracic sympathectomy at segment of T_(3) results in higher incidence rates of CH at 6 months and 12 months after surgery.