Lin T S
Department of General Thoracic Surgery, Changhua Christian Hospital, Chung Shan Medical and Dental College, Taichung, Taiwan, Republic of China.
Pediatr Surg Int. 1999;15(7):475-8. doi: 10.1007/s003830050642.
Primary hyperhidrosis (PH) often starts in childhood and adolescence and can be a troublesome condition. In Taiwan, there is a high incidence in childhood (1.6%-2.0%) and adolescence (2.2%-2.6%). There are few reports regarding transthoracic endoscopic sympathectomy (TES) for PH in children and adolescents. From July 1994 to April 1998, a total of 438 patients underwent TES. There were 174 males and 264 females with a mean age of 14.2 years (range 5-17 years). All patients were placed in a semi-sitting position under single-lumen intubation anesthesia. We performed ablation of the T2 ganglion and any Kuntz fibers in 350 patients with palmar hyperhidrosis and a similar procedure on the T2 and T3 ganglia in 88 patients with palmar and axillary hyperhidrosis using either a 6- or 8-mm thoracoscope via one 0.8-cm incision just below each axilla. In the 438 patients, 875 sympathectomies were performed. There was 1 technical failure due to severe pleural adhesions. TES was usually accomplished within 15 min (range 7-20 min). All except 5 patients were discharged within 4 h after operation. The surgical complication rate was minimal: 1 pneumothorax (0.23%) and 2 segmental lung collapses (0.46%). There was no surgical mortality. The mean postoperative follow-up period was 25.2 months (range 4-45 months). The result was highly satisfactory in 408 patients (93.2%), although 377 (86%) developed compensatory sweating of the trunk and lower limbs, the distribution affecting the back (86%), abdomen (48%), lower limbs (78%), and soles (1.4%). The recurrence rate of palmar hyperhidrosis was 0.6% in the 1st, 1.1% in the 2nd, and 1.7% in the 3rd year. TES is thus a safe and effective method for treating palmar and axillary hyperhidrosis in children and adolescents.
原发性多汗症（PH）通常始于儿童期和青春期，可能是一种令人困扰的病症。在台湾，儿童期发病率较高（1.6%-2.0%），青春期发病率也较高（2.2%-2.6%）。关于儿童和青少年PH的经胸内镜交感神经切除术（TES）的报道较少。1994年7月至1998年4月，共有438例患者接受了TES。其中男性174例，女性264例，平均年龄14.2岁（范围5-17岁）。所有患者在单腔气管插管麻醉下取半坐位。我们对350例掌部多汗症患者进行了T2神经节及任何Kuntz纤维的消融，对88例掌部和腋窝多汗症患者的T2和T3神经节进行了类似操作，通过每个腋窝下方一个0.8厘米的切口，使用6毫米或8毫米的胸腔镜。在这438例患者中，共进行了875次交感神经切除术。因严重胸膜粘连导致1例技术失败。TES通常在15分钟内完成（范围7-20分钟）。除5例患者外，所有患者术后4小时内出院。手术并发症发生率极低：1例气胸（0.23%）和2例节段性肺萎陷（0.46%）。无手术死亡病例。术后平均随访期为25.2个月（范围4-45个月）。408例患者（93.2%）的结果非常满意，尽管377例（86%）出现了躯干和下肢的代偿性出汗，分布影响背部（86%）、腹部（48%）、下肢（78%）和脚底（1.4%）。掌部多汗症的复发率在第1年为0.6%，第2年为1.1%，第3年为1.7%。因此，TES是治疗儿童和青少年掌部和腋窝多汗症的一种安全有效的方法。
