Kao M C
Department of Surgery, College of Medicine, National Taiwan University, Taipei, Republic of China.
Lasers Surg Med. 1992;12(3):308-12. doi: 10.1002/lsm.1900120311.
Hyperhidrosis palmaris is a common disorder among the Orientals. Despite numerous therapeutic modalities in practice, none has proved entirely satisfactory. With the introduction of video-endoscopic surgery, we combined this system with a fiber optic Nd-YAG laser unit, electrocautery, and a laser Doppler flowmeter to design a new and promising therapeutic technique for palmar hyperhidrosis. General anesthesia with alternating one-lung ventilation is essential for a safe and smooth endoscopic sympathectomy. An operating endoscope was introduced into thoracic cavity via the second intercostal space and then attached to a CCD camera video system, which provided clear visibility of the sympathetic trunk in most cases. The proper level of the sympathetic trunk was further confirmed with the aid of vasomotor response of the palmar skin resulting from electric stimulation on the related sympathetic trunk. Finally, the confirmed target was precisely vaporized with a low power Nd-YAG laser through an endoscope. Twenty patients underwent bilateral sympathectomy, mostly on T2 and its adjacent trunk. This technique did not cause any injury to the lung or bleeding. No Horner's syndrome was produced. It provided a precise ganglionectomy on a confirmed target under clear magnified vision. Consequently, a definite and long-lasting therapeutic effect seemed warranted. It was considered to be a relative minor and safe procedure causing minimal discomfort and an almost invisible scar without producing serious complications. It also shortened the operation time and hospital stay remarkably in comparison with other open sympathectomy procedures.
手掌多汗症是东方人中的常见病症。尽管目前有多种治疗方法，但尚无一种被证明完全令人满意。随着视频内镜手术的引入，我们将该系统与光纤Nd-YAG激光装置、电灼器和激光多普勒血流仪相结合，设计出一种治疗手掌多汗症的新的、有前景的治疗技术。采用交替单肺通气的全身麻醉对于安全、顺利地进行内镜下交感神经切除术至关重要。通过第二肋间间隙将手术内镜插入胸腔，然后连接到CCD摄像视频系统，在大多数情况下可清晰显示交感神经干。借助对相关交感神经干进行电刺激后手掌皮肤的血管运动反应，进一步确认交感神经干的合适位置。最后，通过内镜用低功率Nd-YAG激光精确汽化已确认的靶点。20例患者接受了双侧交感神经切除术，主要针对T2及其相邻神经干。该技术未对肺部造成任何损伤或出血。未出现霍纳综合征。它能在清晰放大的视野下对已确认的靶点进行精确的神经节切除术。因此，似乎能产生明确且持久的治疗效果。该手术被认为是一种相对较小且安全的手术，引起的不适最小，疤痕几乎不可见，且不会产生严重并发症。与其他开放性交感神经切除术相比，它还显著缩短了手术时间和住院时间。
