Baumgartner Fritz J, Toh Youn
Center for the Cure of Sweaty Palms, Santa Ana, California, USA.
Ann Thorac Surg. 2003 Dec;76(6):1878-83. doi: 10.1016/s0003-4975(03)01069-5.
Severe hyperhidrosis is a debilitating disorder primarily affecting the palmar, plantar, and axillary regions. The purpose of our study was to review patient characteristics, surgical technique, and outcome of patients undergoing outpatient thoracoscopic sympathectomy for severe hyperhidrosis.
A series of 309 hyperhidrosis patients underwent thoracoscopy for T2-T3 sympathectomy. Of these, 180 underwent prospective evaluation to more precisely identify pre- and postoperative features.
The primary indication for surgery was palmar hyperhidrosis (PH) in 302 of 309 patients (97.7%), although in 7 patients (2.3%) axillary hyperhidrosis (AH) was the primary indication. A family history was elicited in 74 of 132 (56.1%) and a provocative response to hand lotion was present in 101 of 132 (76.5%). Thoracoscopic sympathectomy afforded almost instantaneous cures for PH, with marked improvement in 100% for whom the sympathectomy was done. Of 180 patients prospectively questioned in detail, 173 (96.1%) had some degree of plantar hyperhidrosis. Of these, 148 (84.4%) had some improvement, with 70 (40.5%) achieving complete relief of the plantar hyperhidrosis. In 98 patients who had some complaints of AH, 68 (69.4%) were completely relieved of the AH, while 25 (25.5%) were relieved but not completely cured. In 7 patients, the primary indication for sympathectomy was AH and of these, 3 (42.9%) had complete relief, 2 (28.6%) had partial relief, and 2 (28.6%) had no relief. Of the entire series of 309 patients, 4 (1.3%) developed severe compensatory hyperhidrosis (CH). In 180 prospectively questioned patients, CH was present in 81 (45%).
The most frequent presentation of hyperhidrosis involves the hands and feet. A family history of the disorder is common, and there is usually a provocative effect with hand lotion. Sympathectomy at the level of the T2-T3 ganglia is curative for PH, and in 80% of instances will improve plantar hyperhidrosis when in combination with PH. Sympathectomy for AH is not as effective as for PH. CH is common, occurring in nearly half, but only rarely is extreme and problematic. Bilateral thoracoscopic sympathectomy may be safely done as an outpatient procedure for most patients.
严重多汗症是一种使人衰弱的疾病，主要影响手掌、足底和腋窝部位。我们研究的目的是回顾接受门诊胸腔镜交感神经切除术治疗严重多汗症患者的特征、手术技术及结果。
309例多汗症患者接受了胸腔镜下T2 - T3交感神经切除术。其中，180例接受了前瞻性评估，以更精确地确定术前和术后特征。
309例患者中有302例（97.7%）手术的主要指征是手掌多汗症（PH），不过有7例（2.3%）患者以腋窝多汗症（AH）为主要指征。132例患者中有74例（56.1%）有家族史，132例中有101例（76.5%）对手部乳液有激发反应。胸腔镜交感神经切除术几乎能立即治愈PH，接受交感神经切除术的患者100%有明显改善。在180例接受详细前瞻性询问的患者中，173例（96.1%）有一定程度的足底多汗症。其中，148例（84.4%）有一定改善，70例（40.5%）足底多汗症完全缓解。在98例有AH相关主诉的患者中，68例（69.4%）AH完全缓解，25例（25.5%）缓解但未完全治愈。7例患者交感神经切除术的主要指征是AH，其中3例（42.9%）完全缓解，2例（28.6%）部分缓解，2例（28.6%）无缓解。在整个309例患者系列中，4例（1.3%）出现严重代偿性多汗症（CH）。在180例接受前瞻性询问的患者中，81例（45%）存在CH。
多汗症最常见的表现累及手和脚。该疾病有家族史很常见，且手部乳液通常有激发作用。T2 - T3神经节水平的交感神经切除术可治愈PH，与PH合并存在时，80%的情况下可改善足底多汗症。针对AH的交感神经切除术不如针对PH有效。CH很常见，近半数患者发生，但极端且成问题的情况很少见。对于大多数患者，双侧胸腔镜交感神经切除术可作为门诊手术安全进行。
