Dumont Pascal, Denoyer Alexandre, Robin Patrick
Department of Thoracic, Cardiac, and Vascular Surgery, Unit of Thoracic Surgery, University Hospital of Tours, Tours, France.
Ann Thorac Surg. 2004 Nov;78(5):1801-7. doi: 10.1016/j.athoracsur.2004.03.012.
Thoracoscopic sympathectomy is now the reference treatment for severe palmar hyperhidrosis, but this is offset by the occurrence of compensatory sweating. It has been studied in this series to improve the indications and information given to patients.
A retrospective review of 124 patients who were previously afflicted with bilateral thoracoscopic sympathectomy 6 years earlier was conducted. Patients were interviewed by postal questionnaire regarding the results and side effects.
The series consisted of 89 females (72%) and 35 males and the mean age was 28 years. The main indication was palmo-plantar hyperhidrosis (34%). The mean operating time was 36 minutes and there were no intraoperative complications. Postoperative pneumothorax occurred in 9 patients and 3 patients required a chest drain. The hospital stay was 36 hours for 87.6% of the patients. Postoperative pain occurred in 78% of the patients. Neurologic complications (Horner syndrome, radial paralysis, and dysesthesia of the arm) occurred in 3 patients and disappeared after 2-6 months. Two patients required single-side reoperation because of failure with the first intervention. Eighty-nine replies to questionnaires were received (72%). The results for hands were favorable in 98% and in 63% for axillae. Compensatory sweating occurred in 87% of the patients (serious in 36% and incapacitating in 6%). Despite this 90% of the patients were satisfied or very satisfied.
This study confirms that thoracoscopic sympathectomy is a suitable method of treatment for severe palmar hyperhidrosis but emphasizes the need to offer the patient more informative information, especially regarding compensatory sweating which seems inescapable.
胸腔镜交感神经切除术目前是重度手掌多汗症的标准治疗方法，但会出现代偿性出汗，这抵消了该疗法的优势。本研究系列旨在改善治疗指征并为患者提供更多信息。
对124例6年前接受双侧胸腔镜交感神经切除术的患者进行回顾性研究。通过邮寄问卷对患者进行访谈，了解手术结果和副作用。
该系列包括89名女性（72%）和35名男性，平均年龄为28岁。主要指征是掌跖多汗症（34%）。平均手术时间为36分钟，无术中并发症。9例患者术后发生气胸，3例患者需要胸腔引流。87.6%的患者住院时间为36小时。78%的患者术后出现疼痛。3例患者出现神经并发症（霍纳综合征、桡神经麻痹和手臂感觉异常），2 - 6个月后消失。2例患者因首次手术失败需要单侧再次手术。共收到89份问卷回复（72%）。手部手术效果良好的占98%，腋窝手术效果良好的占63%。87%的患者出现代偿性出汗（严重的占36%，导致功能丧失的占6%）。尽管如此，90%的患者表示满意或非常满意。
本研究证实胸腔镜交感神经切除术是治疗重度手掌多汗症的合适方法，但强调需要向患者提供更多信息，尤其是关于似乎难以避免的代偿性出汗的信息。
