原发性多汗症的外科治疗

Surgical treatment for primary hyperhidrosis

原发性多汗症的最佳的治疗方法一直存在争议。虽然手术比其他治疗方法创伤大、风险高,但手术治疗效果显著有效。目前国内外大量研究阐明内镜下胸交感神经链切断术(ETS)是原发性多汗症的最佳治疗方法。R3或R4水平切断交感神经链治疗手汗症效果最佳;对于手和腋窝多汗,手、腋窝和足多汗患者,推荐于R4水平行ETS。对于头面部多汗患者,建议在R3水平离断交感神经链;对于单纯腋窝多汗症患者,推荐使用局部吸刮手术治疗,ETS作为二线手术方案。

Significant controversies surround the optimal treatment of primary hyperhidrosis. Despite carrying elevated risk as they are significantly more invasive than other treatments available, evidence supports the efficacy of these procedures. A lot of studies suggest that primary hyperhidrosis is best treated by endoscopic thoracic sympathectomy(ETS). An international nomenclature should be adopted that refers to the rib levels(R) instead of the vertebral level at which the nerve is interrupted. The recent literature suggests that the highest success rates occur when interruption is performed at R3 or R4 for palmar-only hyperhidrosis. Interruption at R4 is suitable for palmar and axillary, and palmar, axillary and pedal hyperhidrosis, while interruption at R3 is best for craniofacial hyperhidrosis. Curettage or liposuction is the best surgery way for axillary-only hyperhidrosis, and ETS generally remains second-line option.