Vigil Laura, Calaf Nuria, Codina Esperança, Fibla Juan José, Gómez Guillermo, Casan Pere
Department of Medicine, Autonomous University of Barcelona, [corrected] Spain.
Chest. 2005 Oct;128(4):2702-5. doi: 10.1378/chest.128.4.2702.
Essential hyperhidrosis is characterized by overactivity of the sympathetic fibers passing through the upper-dorsal ganglia (second and third thoracic ganglia [D2-D3]), and the treatment of choice is video-assisted thoracoscopy sympathectomy. Alterations in cardiopulmonary function after treatment have been reported.
To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis.
Prospective controlled trial at a pulmonary function unit of a university hospital.
Twenty patients (2 men and 18 women) with essential hyperhidrosis.
Pulmonary function tests, including spirometry and thoracic gas volume, bronchial challenge with methacholine, and maximal exercise, were performed before and 3 months after D2-D3 sympathectomy. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of D2-D3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal midexpiratory flow was the only variable that showed significant changes, from 101% (SD, 26%) to 92% (SD, 27%) [p < 0.05]. Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test.
Video-assisted thoracoscopy is a safe treatment, and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in the presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in HR. The clinical importance of these findings is not significant.
原发性多汗症的特征是穿过上胸段神经节（第二和第三胸神经节 [D2 - D3]）的交感神经纤维活动过度，而首选治疗方法是电视辅助胸腔镜交感神经切除术。已有报道称该治疗后心肺功能会发生改变。
评估原发性多汗症患者交感神经切除术后的心肺功能损害。
在一家大学医院的肺功能科进行的前瞻性对照试验。
20例原发性多汗症患者（2例男性和18例女性）。
在D2 - D3交感神经切除术前后进行了肺功能测试，包括肺活量测定和胸腔气体容积测定、用乙酰甲胆碱进行支气管激发试验以及最大运动试验。采用一期双侧手术对D2 - D3神经节进行电凝来实施电视辅助交感神经切除术。两组的肺功能值（肺活量测定值和容积）无统计学差异。最大呼气中期流速是唯一显示出显著变化的变量，从101%（标准差，26%）降至92%（标准差，27%）[p < 0.05]。10例患者支气管激发试验结果为阳性，术后3个月仍为阳性，2例术前激发试验结果为阴性的患者在交感神经切除术后变为阳性。在最大运动试验期间观察到最大心率（HR）、氧摄取和二氧化碳摄取显著降低。
电视辅助胸腔镜检查是一种安全的治疗方法，观察到的心肺功能改变仅提示在存在支气管高反应性阳性和HR轻度交感神经阻滞的情况下有最小程度的小气道改变。这些发现的临床意义不大。
