Neumayer C, Zacherl J, Holak G, Függer R, Jakesz R, Herbst F, Bischof G
Department of General Surgery, University Clinic of Surgery, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Surg Endosc. 2004 Jan;18(1):152-6. doi: 10.1007/s00464-002-8940-5. Epub 2003 Nov 21.
Endoscopic thoracic sympathicotomy of T2 to T4 (ETS 2-4) has evolved into an effective treatment for severe hyperhidrosis of the upper limb. Complications such as bleeding or Horner's syndrome are rare, but side effects such as compensatory and gustatory sweating occur in 30-50% of patients. Following the Lin-Telaranta classification, we aimed to reduce these side-effects by clipping T4 solely [endoscopic thoracic sympathetic block (ESB 4)]. We present our experience and clinical results using this method, with emphasis on patients' quality of life.
A total of 176 procedures (91 patients) were carried out in the ETS 2-4 group and 103 procedures (53 patients) in the ESB 4 group: 60.4 and 43.4% had palmar hyperhidrosis, 8.8 and 5.7% had isolated axillary, and 30.8 and 50.9% had combined manifestations, respectively. Follow-up was 22.1 months (obtained from 79.1% of patients) for the ETS 2-4 group and 7.5 months for the ESB 4 group (obtained from 88.7%).
The success rate was similar for both groups: 87.9 and 64.5% had completely dry limbs, 9.9 and 35.5% ( p < 0.0002) were nearly dry, and 2.1 and 0% remained wet. (ETS 2-4 vs ESB 4). Although the armpits remained slightly humid in more patients in the ESB 4 group, 100% stated full satisfaction. Complications did not differ significantly. However, compensatory sweating (55.6 vs 8.5%, p = 0.0002) and gustatory sweating (33.3 vs 2.1%, p = 0.0019) were markedly reduced (ETS 2-4 vs ESB 4). Quality of life was assessed by a hyperhidrosis index, which significantly improved in most patients.
ETS 2-4 and ESB 4 have similar success rates in the treatment of upper limb hyperhidrosis. The major side effects of compensatory and gustatory sweating were effectively reduced by the limited method of clipping T4, and patients' satisfaction and improvement in quality of life were remarkable.
胸段第2至4节交感神经内镜切断术（ETS 2-4）已发展成为治疗上肢严重多汗症的有效方法。出血或霍纳综合征等并发症很少见，但30%-50%的患者会出现代偿性出汗和味觉性出汗等副作用。按照林-特拉兰塔分类法，我们旨在通过仅钳夹T4[胸段交感神经阻滞（ESB 4）]来减少这些副作用。我们介绍了使用这种方法的经验和临床结果，重点关注患者的生活质量。
ETS 2-4组共进行了176例手术（91例患者），ESB 4组进行了103例手术（53例患者）：分别有60.4%和43.4%的患者患有手掌多汗症，8.8%和5.7%的患者患有单纯腋窝多汗症，30.8%和50.9%的患者患有合并症状。ETS 2-4组的随访时间为22.1个月（来自79.1%的患者），ESB 4组为7.5个月（来自88.7%的患者）。
两组的成功率相似：87.9%和64.5%的患者肢体完全干燥，9.9%和35.5%（p<0.0002）几乎干燥，2.1%和0%的患者仍潮湿。（ETS 2-4组与ESB 4组）。虽然ESB 4组更多患者的腋窝仍稍有潮湿，但100%的患者表示完全满意。并发症无显著差异。然而，代偿性出汗（55.6%对8.5%，p = 0.0002）和味觉性出汗（33.3%对2.1%，p = 0.0019）明显减少（ETS 2-4组与ESB 4组）。通过多汗症指数评估生活质量，大多数患者的生活质量显著改善。
ETS 2-4和ESB 4在治疗上肢多汗症方面成功率相似。通过有限的钳夹T4方法有效减少了代偿性出汗和味觉性出汗等主要副作用，患者的满意度和生活质量改善显著。
