Vallières E
Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle 98195, USA.
Neurosurg Clin N Am. 2001 Apr;12(2):321-7.
Thoracoscopic sympathectomy provides a superb surgical option for the many patients with incapacitating essential hyperhidrosis. Whether one thoracoscopic approach to sympathectomy is ever likely to prevail is doubtful, as the results of the various reported techniques seem to be quite similar. There are definite advantages to the single-port approaches, which are faster and usually do not require repositioning of the patient to do both sides. In the rare instances where dense apical adhesions are encountered or when significant bleeding is encountered from one of the intercostal vessels, the two- or three-port approaches definitely provide better control (see commentary in article by Kohno and Takamoto). Surgeon preference probably dictates which approach is used at the different centers. Compensatory sweating remains a frequent and sometimes serious complication of the procedure, particularly in individuals living in hot climates. An understanding of its mechanisms needs improvement, with the hope of preventing its occurrence in the future. In the meantime, patients have to be informed of its frequency, and operations could probably be tailored to the patients' needs and their local climate.
胸腔镜交感神经切除术为众多患有使人衰弱的原发性多汗症的患者提供了一种极好的手术选择。由于各种报道技术的结果似乎相当相似，一种胸腔镜交感神经切除术方法是否可能占主导地位尚不确定。单孔入路有明确的优势，其速度更快，通常不需要重新摆放患者体位来进行双侧手术。在罕见的遇到致密的尖部粘连或肋间血管之一出现大量出血的情况下，两孔或三孔入路肯定能提供更好的控制（见 Kohno 和 Takamoto 文章中的评论）。不同中心使用哪种方法可能由外科医生的偏好决定。代偿性出汗仍然是该手术常见且有时严重的并发症，尤其是在生活在炎热气候地区的个体中。对其机制的理解需要改进，以期在未来预防其发生。与此同时，必须告知患者其发生频率，并且手术可能可以根据患者的需求及其当地气候进行调整。
