Chou S-H, Kao E-L, Lin C-C, Chang Y-T, Huang M-F
Department of Surgery, Faculty of Medical School, College of Medicine, Kaohsiung Medical University, 100 Shih Chuan 1st Road, Kaohsiung, 80708, Taiwan.
Surg Endosc. 2006 Nov;20(11):1749-53. doi: 10.1007/s00464-005-0829-7. Epub 2006 Oct 5.
Compensatory hyperhidrosis is the most troublesome side effect and the leading cause of regret with sympathetic surgery. A new classification is proposed to make the procedure more selective and to minimize the side effects and regret rate. Also, a proposed mechanism for compensatory hyperhidrosis is discussed.
Between January 2002 and July 2003, 464 patients with various sympathetic disorders underwent thoracoscopic sympathectomy/sympathicotomy (ETS) or sympathetic block by clipping (ESB) at various levels according to the authors' classification. The surgery was performed on an outpatient basis. The rates of success, compensatory hyperhidrosis, and regret were recorded.
All the patients were followed up for 17 to 35 months. All excessive sweating was effectively stopped to varying degrees. The 25 patients with palmar hyperhidrosis who insisted on receiving ETS of T4 experienced no compensatory hyperhidrosis. Of the 54 patients with facial blushing who received ESB of T2, 23 experienced compensatory hyperhidrosis. Nine patients expressed regret and requested removal of the clips. Of the 33 patients with craniofacial hyperhidrosis who received ESB of T3, 9 experienced compensatory hyperhidrosis. Three expressed regret, and reverse procedures were performed. For 324 patients with palmar hyperhidrosis receiving ESB of T4, no compensatory hyperhidrosis was found. Only two expressed regret because of discomfort. No compensatory hyperhidrosis or regret was noted with 28 patients who received ESB of T5 for axillary sweating. There was no recurrence in the entire series.
Different procedures are recommended for different sympathetic disorders according to the classification. The higher the level of sympathetic ganglion blockade, the higher is the regret rate. Therefore, for T2 and T3 ganglion, endoscopic thoracic sympathetic block by the clipping method is strongly recommended because of its reversibility.
代偿性多汗是交感神经手术最麻烦的副作用，也是导致患者后悔接受手术的主要原因。本文提出一种新的分类方法，以使手术更具选择性，并尽量减少副作用和后悔率。此外，还讨论了代偿性多汗的一种可能机制。
2002年1月至2003年7月，464例患有各种交感神经紊乱的患者根据作者的分类在不同水平接受了胸腔镜交感神经切除术/交感神经切断术（ETS）或夹闭交感神经阻滞（ESB）。手术在门诊进行。记录成功率、代偿性多汗发生率和后悔率。
所有患者均随访17至35个月。所有多汗症状均得到不同程度的有效缓解。25例坚持接受T4节段ETS的掌部多汗患者未出现代偿性多汗。54例接受T2节段ESB的面部潮红患者中，23例出现代偿性多汗。9例患者表示后悔并要求取出夹子。33例接受T3节段ESB的颅面部多汗患者中，9例出现代偿性多汗。3例表示后悔，并进行了逆转手术。324例接受T4节段ESB的掌部多汗患者未发现代偿性多汗。只有2例因不适表示后悔。28例接受T5节段ESB治疗腋窝多汗的患者未出现代偿性多汗或后悔情况。整个系列中无复发病例。
根据分类，针对不同的交感神经紊乱推荐不同的手术方法。交感神经节阻滞水平越高，后悔率越高。因此，对于T2和T3神经节，强烈推荐采用夹闭法进行内镜胸交感神经阻滞，因其具有可逆性。
