Gossot Dominique, Galetta Domenico, Pascal Antoine, Debrosse Denis, Caliandro Raffaele, Girard Philippe, Stern Jean-Baptiste, Grunenwald Dominique
Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
Ann Thorac Surg. 2003 Apr;75(4):1075-9. doi: 10.1016/s0003-4975(02)04657-x.
Immediate results of endoscopic thoracic sympathectomy (ETS) for hyperhidrosis are good. Adverse effects are well known but are supposed to decrease with time. We report the long-term results of ETS with regard to efficacy, side effects and patient satisfaction.
From 1993 to 1998, 382 patients suffering from hyperhidrosis of the upper limbs were operated on by means of bilateral ETS. One hundred twenty-five could be reached. There were 91 females and 34 males with a mean age of 28 years. The mean follow-up was 3.8 years (range: 24 to 84 months). Patients answered a detailed questionnaire from an independent observer addressing the following issues: stability of the initial result, outcome of side effects, degree of satisfaction.
The global recurrence rate was 8.8%: 6.6% for palmar hyperhidrosis and 65% for axillary hyperhidrosis. Compensatory sweating was observed in 86.4% of the patients. It was considered as minor by 61% of them, as embarrassing by 31.5%, and as disabling by 7.5%. Other reported side effects were: Horner's syndrome in 3 patients (2.4%), healing in 2 of them; chronic rhinitis in 3 (2.4%); gustatory sweating in 9 (7.2%); and hand dryness in 42%. Sixty-five percent of the patients were fully satisfied, 28.7% were globally satisfied, and 6.3% regretted the operation. Ninety-two percent of the patients claimed they would ask for the operation if it were to be redone.
This study confirms that results of ETS are good and stable for palmar hyperhidrosis but deteriorate for axillary hyperhidrosis. Compensatory sweating does not improve with time and is the main cause of dissatisfaction. Recommendations drawn from these results are the following: (1) patients suffering from isolated axillary hyperhidrosis should rather be treated by local therapy; (2) patients should be better informed of adverse effects.
内镜下胸交感神经切断术（ETS）治疗多汗症的近期效果良好。其不良反应众所周知，但一般认为会随时间推移而减轻。我们报告了ETS在疗效、副作用及患者满意度方面的长期结果。
1993年至1998年，382例上肢多汗症患者接受了双侧ETS手术。其中125例患者可联系到。患者中女性91例，男性34例，平均年龄28岁。平均随访时间为3.8年（范围：24至84个月）。患者回答了一份由独立观察者提供的详细问卷，问卷涉及以下问题：初始结果的稳定性、副作用的情况、满意程度。
总体复发率为8.8%：掌部多汗症复发率为6.6%，腋窝多汗症复发率为65%。86.4%的患者出现了代偿性出汗。其中61%的患者认为代偿性出汗轻微，31.5%的患者认为令人尴尬，7.5%的患者认为代偿性出汗导致功能丧失。其他报告的副作用包括：3例患者（2.4%）出现霍纳综合征，其中2例恢复；3例患者（2.4%）出现慢性鼻炎；9例患者（7.2%）出现味觉性出汗；42%的患者出现手部干燥。65%的患者完全满意，28.7%的患者总体满意，6.3%的患者后悔接受手术。92%的患者表示如果再次手术，他们仍会要求进行。
本研究证实，ETS治疗掌部多汗症的效果良好且稳定，但治疗腋窝多汗症的效果会逐渐变差。代偿性出汗不会随时间改善，是导致患者不满意的主要原因。基于这些结果得出的建议如下：（1）单纯腋窝多汗症患者应优先采用局部治疗；（2）应更好地告知患者不良反应。
