Lin T S, Fang H Y, Wu C Y
General Thoracic Surgery, Changhua Christian Hospital, No. 135, Nan-Siau Street, Changhua City, Taiwan, ROC.
Surg Endosc. 2000 Feb;14(2):134-6. doi: 10.1007/s004649900084.
Patients undergoing an unsuccessful sympathectomy experience dryness on one hand and excessive sweating on the other. This is embarrassing for the patients, and resolution of both a previous failed sympathectomy and recurrent hyperhidrosis is important.
From September 1995 to January 1998, 24 patients (11 men and 13 women; mean age, 28.2 years) underwent repeat transthoracic sympathectomy (TES). The repeat TES was performed with patients under general anesthesia using either a standard single-lumen endotracheal tube (12 patients) or a double-lumen endotracheal tube (12 patients). Ablation of T2 and T3 ganglia and any Kuntz fiber was performed in treating patients with palmar hyperhidrosis, and a similar procedure was performed on T3 and T4 ganglia for patients with axillary hyperhidrosis.
The reasons for failure of the previous TES were pleural adhesion (14/24), intact T2 ganglion (5/24), aberrant venous arch drainage to the superior vena cava (2/24), incomplete interruption of sympathetic nerve (2/24), and possible reinnervation (1/24). The mean operation time was 28 min (range, 18-72 min). In all, 23 patients had a satisfactory result, without recurrence of palmar or axillary hyperhidrosis. The mean follow-up time was 22 months (range, 5-30 months). The average hospital stay was 1.8 days. There was no surgical mortality.
Repeat TES is a safe and effective method for treating both an unsuccessful sympathectomy and recurrent palmar or axillary hyperhidrosis.
交感神经切除术失败的患者会出现一侧手部干燥而另一侧多汗的情况。这让患者感到尴尬，解决既往交感神经切除术失败和复发性多汗症的问题很重要。
1995年9月至1998年1月，24例患者（11例男性和13例女性；平均年龄28.2岁）接受了重复经胸交感神经切除术（TES）。重复TES在全身麻醉下进行，使用标准单腔气管导管（12例患者）或双腔气管导管（12例患者）。治疗手掌多汗症患者时，切除T2和T3神经节以及任何Kuntz纤维，治疗腋窝多汗症患者时，对T3和T4神经节进行类似操作。
既往TES失败的原因包括胸膜粘连（14/24）、T2神经节完整（5/24）、异常静脉弓引流至上腔静脉（2/24）、交感神经中断不完全（2/24）以及可能的神经再支配（1/24）。平均手术时间为28分钟（范围18 - 72分钟）。总共有23例患者结果满意，手掌或腋窝多汗症未复发。平均随访时间为22个月（范围5 - 30个月）。平均住院时间为1.8天。无手术死亡病例。
重复TES是治疗交感神经切除术失败以及复发性手掌或腋窝多汗症的一种安全有效的方法。
