Chen H J, Liang C L, Lu K
Department of Neurosurgery, Chang Gung University and Medical Center at Kaohsiung, Taiwan.
J Neurosurg. 2001 Jul;95(1 Suppl):58-63. doi: 10.3171/spi.2001.95.1.0058.
Transthoracic endoscopic T2-3 sympathectomy is currently the treatment of choice for palmar hyperhidrosis. Compensatory sweating of the face, trunk, thigh, and sole of the foot was found in more than 50% of patients who underwent this procedure. The authors conducted this study to investigate the associated intraoperative changes in plantar skin temperature and postoperative plantar sweating.
One hundred patients with palmar hyperhidrosis underwent bilateral transthoracic endoscopic T2-3 sympathectomy. There were 60 female and 40 male patients who ranged in age from 13 to 40 years (mean age 21.6 years). Characteristics studied included changes in palmar and plantar skin temperature measured intraoperatively, as well as pre- and postoperative changes in plantar sweating and sympathetic skin responses (SSRs). In 59 patients (59%) elevation of plantar temperature was demonstrated at the end of the surgical procedure. In this group, plantar sweating was found to be exacerbated in three patients (5%); plantar sweating was improved in 52 patients (88.1%); and no change was demonstrated in four patients (6.8%). In the other group of patients in whom no temperature change occurred, increased plantar sweating was demonstrated in three patients (7.3%); plantar sweating was improved in 20 patients (48.8%); and no change was shown in 18 patients (43.9%). The difference between temperature and sweating change was significant (p = 0.001). Compared with the presympathectomy rate, the rate of absent SSR also significantly increased after sympathectomy: from 20 to 76% after electrical stimulation and 36 to 64% after deep inspiration stimulation, respectively (p < 0.05).
In contrast to compensatory sweating in other parts of the body after T2-3 sympathetomy, improvement: in plantar sweating was shown in 72% and worsened symptoms in 6% of patients. The intraoperative plantar skin temperature change and perioperative SSR demonstrated a correlation between these changes.
经胸内镜下T2-3交感神经切除术目前是治疗手掌多汗症的首选方法。超过50%接受该手术的患者出现了面部、躯干、大腿和足底的代偿性出汗。作者开展本研究以调查术中足底皮肤温度的相关变化以及术后足底出汗情况。
100例手掌多汗症患者接受了双侧经胸内镜下T2-3交感神经切除术。其中女性60例，男性40例，年龄在13至40岁之间（平均年龄21.6岁）。研究的特征包括术中测量的手掌和足底皮肤温度变化，以及术前和术后足底出汗和交感神经皮肤反应（SSR）的变化。59例患者（59%）在手术结束时出现足底温度升高。在该组中，3例患者（5%）足底出汗加剧；52例患者（88.1%）足底出汗改善；4例患者（6.8%）无变化。在另一组未出现温度变化的患者中，3例患者（7.3%）足底出汗增加；20例患者（48.8%）足底出汗改善；18例患者（43.9%）无变化。温度和出汗变化之间的差异具有显著性（p = 0.001）。与交感神经切除术前相比，交感神经切除术后SSR缺失率也显著增加：电刺激后从20%增至76%，深吸气刺激后从36%增至64%（p < 0.05）。
与T2-3交感神经切除术后身体其他部位的代偿性出汗不同，72%的患者足底出汗得到改善，6%的患者症状加重。术中足底皮肤温度变化与围手术期SSR显示出这些变化之间存在相关性。
