电视纵隔镜胸交感神经链切断术治疗手汗症55例报告

Thoracic sympathectomy under video mediastinoscopy for palmar hyperhidrosis: Report of 55 cases

目的 探讨电视纵隔镜胸交感神经链切断术治疗手汗症的可行性。 方法 双腔气管插管全麻 ,30°～ 4 5°半坐位 ,两臂外展 90°,电视纵隔镜从腋前线第 3肋间小切口置入 ,电钩切断T2 ～T4交感神经链。 结果 手术时间 2 0～ 4 0min ,平均 30min。单纯手汗合并而部及腋窝多汗均消失 ,双手温度上升 1 5～ 3℃ ,温暖而干燥。住院 3～ 7d ,平均 4d。无严重并发症发生 ,轻度皮下气肿伴气胸 3例 ,背部代偿性多汗 5例。 结论 电视纵隔镜胸交感神经链切断术治疗手汗症可行。比常规电视胸腔镜减少 1～ 2个切口 ,操作简单 ,病人易于接受 ,可部分取代电视胸腔镜手术。

Objective To explore the feasibility of thoracic sympathectomy under video mediastinoscopy (VM) for palmar hyperhidrosis. Methods Operations on 55 patients with palmar hyperhidrosis were performed under general anesthesia with double lumen endotracheal tube placement. The patients were maintained in the 30°～45° semi-sitting position, with abduction of both arms to 90°. The VM entered the thoracic cavity via the third intercostal space on the anterior axillary line. The T 2～T 4 sympathetic ganglions were resected by electrocautery. Results Hyperhidrosis disappeared postoperatively in all the cases. The temperature of patients' both hands increased by 1.5～3 ℃,with their both hands becoming dry and warm. The operation time was 20～40 min (mean, 30 min) and the hospital stay was 3～7 d (mean, 4 d). No severe complications occurred. Mild subcutaneous emphysema along with pneumothorax was found in 3 cases and compensatory hyperhidrosis in the trunk happened in 5 cases. Conclusions Thoracic sympathectomy under VM is less invasive and simpler than that under video-assisted thoracoscopic surgery (VATS) in the treatment of palmar hyperhidrosis, being a feasible alternative.