Lin T S
Division of General Thoracic Surgery, Changhua Christian Hospital, Chung Shan Medical and Dental College, Taichung, Taiwan, Republic of China.
Ann Thorac Surg. 2001 Sep;72(3):895-8. doi: 10.1016/s0003-4975(01)02852-1.
There are rare reports of video-assisted thoracoscopic resympathicotomy for patients with palmar hyperhidrosis. I present our experience in treating a persistent or recurrent palmar hyperhidrosis after primary endoscopic sympathectomy or sympathicotomy and discuss the perioperative management.
We reoperated on 42 patients using a technique of video-assisted thoracoscopic resympathicotomy. All patients were placed in a semi-sitting position under single- or double-lumen intubated anesthesia. An 8-mm, 0 degrees thoracoscope was used to interrupt the nerve conduction to the palms from the T2 and T3 ganglia, through one or two 0.8-cm subaxillary incisions.
The reasons for failure of endoscopic sympathectomy or sympathicotomy in 26 patients included pleural adhesion (15 of 26, 57.7%), incorrect identification of T2 ganglion (3 of 26, 11.5%), vessel overriding or close to sympathetic nerve (3 of 26, 11.5%), incomplete interruption of sympathetic nerve (2 of 26, 7.7%), medially located sympathetic nerve (2 of 26, 7.7%), and aberrant venous arch (1 of 26, 3.8%). The causes of recurrent palmar hyperhidrosis after primary transthoracic endoscopic sympathicotomy or sympathectomy (TES) in 16 patients included a possible effect of T3 ganglion (8 of 16, 50%), Kuntz fiber (3 of 16, 18.8%), nerve regeneration (3 of 16, 18.8%), and incomplete interruption of T2 ganglion (2 of 16, 12.5%). Surgical complications included pneumothorax (1 patient, 2.4%), hemothorax (1 patient, 2.4%), and compensatory sweating (36 patients, 86%). All patients had obtained successful bilateral sympathectomies and had satisfactory results after a mean of 32.1 months of follow-up.
Video-assisted thoracoscopic resympathicotomy is an effective and safe method for a previously unsuccessful sympathectomy or recurrent palmar hyperhidrosis if the surgeon acknowledges possible anatomic variations and can overcome the problems related to pleural adhesions.
关于电视辅助胸腔镜下再次胸交感神经切断术治疗手掌多汗症患者的报道很少。本文介绍我们在治疗初次内镜胸交感神经切断术或胸交感神经切断术后持续性或复发性手掌多汗症方面的经验，并讨论围手术期管理。
我们采用电视辅助胸腔镜下再次胸交感神经切断术对42例患者进行了再次手术。所有患者在单腔或双腔气管插管麻醉下取半坐位。使用8毫米、0度胸腔镜通过一两个0.8厘米的腋下切口中断从T2和T3神经节到手掌的神经传导。
26例内镜胸交感神经切断术或胸交感神经切断术失败的原因包括胸膜粘连（26例中的15例，57.7%）、T2神经节识别错误（26例中的3例，11.5%）、血管覆盖或靠近交感神经（26例中的3例，11.5%）、交感神经中断不完全（26例中的2例，7.7%）、交感神经位于内侧（26例中的2例，7.7%）以及异常静脉弓（26例中的1例，3.8%）。16例初次经胸内镜胸交感神经切断术或胸交感神经切断术（TES）后复发性手掌多汗症的原因包括T3神经节可能的影响（16例中的8例，50%）、Kuntz纤维（16例中的3例，18.8%）、神经再生（16例中的3例，18.8%）以及T2神经节中断不完全（16例中的2例，12.5%）。手术并发症包括气胸（1例患者，2.4%）、血胸（1例患者，2.4%）和代偿性出汗（36例患者，86%）。所有患者均成功进行了双侧胸交感神经切断术，平均随访32.1个月后效果满意。
如果外科医生认识到可能的解剖变异并能克服与胸膜粘连相关的问题，电视辅助胸腔镜下再次胸交感神经切断术是一种治疗先前失败的胸交感神经切断术或复发性手掌多汗症的有效且安全的方法。
