Ghisletta N, Habicht J, Stulz P
Klinik für Herz- und Thoraxchirurgie, Universitätsspital Basel.
Schweiz Med Wochenschr. 1999 Jul 3;129(26):985-92.
Video-assisted thoracoscopic (VATS) sympathectomy is the most frequently used technique for surgical sympathectomy of the upper limbs. It has proven to be particularly effective in hyperhidrosis of the hands. The aim of this study is to review and discuss possible indications and analyse our own results from 1995 to 1997, including technical details on the use of a new 2-mm thoracoscope and instrumentation.
Data of all 14 consecutive patients were prospectively assessed (8 females, 6 males, mean age 44 years; range 22-74 years). A total of 26 thoracoscopic sympathectomies were performed. Indications included: 7 cases of hyperhidrosis, 4 of inoperable and medically intractable angina pectoris, 3 of vascular diseases of the upper extremity. All patients were reexamined 3 months postoperatively and late follow-up was obtained in all patients, with a mean follow-up of 20 months postoperatively (4-36 months) by questionnaire.
22 Th2-Th5 and 4 Th2-Th4 resections of the sympathetic chain were performed. There was no conversion to open surgery. The mean operating time was 67 minutes (range 50-90 min.). One (3.8%) unilateral Horner syndrome occurred with complete recovery during follow up. Compensatory sweating occurred in 7 (50%). The mean hospitalisation was 4.7 days for all patients and 2.8 days for those with hyperhidrosis. In 10 patients (71.5%), symptoms of the underlying disease had completely ceased on the day of discharge, and in 4 (28.5%) the symptoms had improved. Two months postoperatively a unilateral relapse occurred in one patient with Raynaud's disease. After a mean of 20 months, the quality of life was improved in 12 (85%) and was unchanged as compared to preoperatively in 2 (15%).
Primary hyperhidrosis showed the best results after thoracoscopic sympathectomy. Although experience with angina pectoris is still limited, thoracoscopic sympathectomy seems to be a valuable alternative in otherwise inoperable cases. In upper-extremity vascular diseases the operation can be performed as a last therapeutic option, but relapse often occurs in these patients. 2-mm instrumentation decreases trauma and postoperative pain and improves cosmetic results, which obviously may play a role in younger patients with hyperhidrosis. Patients should be warned about compensatory sweating before thoracic sympathectomy.
电视辅助胸腔镜（VATS）交感神经切除术是上肢手术交感神经切除术最常用的技术。它已被证明在手部多汗症中特别有效。本研究的目的是回顾和讨论可能的适应症，并分析我们1995年至1997年的自身结果，包括使用新型2毫米胸腔镜和器械的技术细节。
对连续14例患者的数据进行前瞻性评估（8例女性，6例男性，平均年龄44岁；范围22 - 74岁）。共进行了26例胸腔镜交感神经切除术。适应症包括：7例多汗症，4例无法手术且药物治疗难以控制的心绞痛，3例上肢血管疾病。所有患者术后3个月复查，并通过问卷调查对所有患者进行了后期随访，术后平均随访20个月（4 - 36个月）。
进行了22例T2 - T5和4例T2 - T4交感神经链切除术。无转为开放手术的情况。平均手术时间为67分钟（范围50 - 90分钟）。发生1例（3.8%）单侧霍纳综合征，随访期间完全恢复。7例（50%）出现代偿性出汗。所有患者的平均住院时间为4.7天，多汗症患者为2.8天。10例患者（71.5%）在出院当天基础疾病症状完全消失，4例（28.5%）症状有所改善。1例雷诺病患者术后2个月出现单侧复发。平均20个月后，12例（85%）患者生活质量改善，2例（15%）与术前相比无变化。
原发性多汗症在胸腔镜交感神经切除术后效果最佳。虽然心绞痛方面的经验仍然有限，但胸腔镜交感神经切除术在其他无法手术的病例中似乎是一种有价值的选择。在上肢血管疾病中，该手术可作为最后的治疗选择，但这些患者常出现复发。2毫米器械减少了创伤和术后疼痛，改善了美容效果，这显然可能对年轻多汗症患者起作用。在胸腔交感神经切除术之前应告知患者有关代偿性出汗的情况。
