Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, Ferrer G
Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, Barcelona, Spain.
Surg Endosc. 2006 Apr;20(4):598-602. doi: 10.1007/s00464-005-0557-z. Epub 2006 Jan 25.
Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard treatment for palmar or axillary hyperhidrosis, is regarded as a safe procedure. This study evaluates the quantitative and qualitative incidence of intraoperative and postoperative complications resulting from bilateral thoracic sympathicolysis.
From 1996 to 2004, 458 consecutive patients with primary hyperhidrosis underwent surgery. These patients comprised 143 men (31.2%) and 315 women (68.7%) with a mean age of 26 years (range, 14-52 years). In all but seven cases, the procedure was bilaterally synchronous.
No mortality was recorded. The anhydrosis rate was 97.4%, with a hypohidrosis rate of 2.4% and a failure rate of 0.2%. The latter was resolved with reintervention. The mean hospital stay was 17 h. The rate of major perioperative complications with conversion to thoracotomy was 0.4%. The overall rate of postoperative complications was 3.6%. The complications and rates observed were as follows: pneumothorax (2.06%), subcutaneous emphysema (1.08%), pleural bleeding (0.2%), hemothorax (0.1%), and atelectasis (0.1%). Compensatory hyperhidrosis was observed in 48.4% of the patients, but the sensation of compensatory hyperhidrosis was reported in 85.6% of the cases. Excessive dryness of the hands was reported in 0.38%, Horner's syndrome in 0.32%, and gustatory hyperhidrosis in 1.1% of the cases. The overall satisfaction rate was 88.5%.
The results suggest that endoscopic bilateral thoracic sympathicolysis is an effective method for managing primary hyperhidrosis, especially severe palmar hyperhidrosis, but it is necessary to inform patients fully concerning the undesirable effects.
双侧上胸交感神经切除术或交感神经松解术是目前治疗手掌或腋窝多汗症的标准方法，被认为是一种安全的手术。本研究评估双侧胸交感神经松解术所致术中及术后并发症的定量和定性发生率。
1996年至2004年，458例连续性原发性多汗症患者接受了手术。这些患者包括143名男性（31.2%）和315名女性（68.7%），平均年龄26岁（范围14 - 52岁）。除7例患者外，手术均为双侧同步进行。
无死亡病例记录。无汗率为97.4%，少汗率为2.4%，失败率为0.2%。后者通过再次干预得到解决。平均住院时间为17小时。围手术期转为开胸手术的主要并发症发生率为0.4%。术后并发症总发生率为3.6%。观察到的并发症及发生率如下：气胸（2.06%）、皮下气肿（1.08%）、胸膜出血（0.2%）、血胸（0.1%）和肺不张（0.1%）。48.4%的患者出现代偿性多汗，但85.6%的病例报告有代偿性多汗的感觉。0.38%的病例报告手部过度干燥，0.32%的病例出现霍纳综合征，1.1%的病例出现味觉性多汗。总体满意率为88.5%。
结果表明，内镜下双侧胸交感神经松解术是治疗原发性多汗症，尤其是严重手掌多汗症的有效方法，但有必要让患者充分了解其不良影响。
