Wei Xiang, Pan Tie-cheng, Li Jun, Tang Ying-xiong, Hu Min, Chen Tao, Liu Li-gang, Xu Li-jun, Alfred Omo
Department of Cardiothoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Zhonghua Wai Ke Za Zhi. 2006 Jul 15;44(14):949-51.
To evaluate the safety and efficacy of needlescopic thoracic sympathectomy for palmar hyperhidrosis.
From March 2004 to April 2005, 62 patients, including 23 men and 39 women with a mean age of 23 years (ranged from 12 to 53 years), underwent bilateral needlescopic thoracic sympathectomy. Among all the patients 8 cases had accompanied axillary hyperhidrosis. The degree of palmar sweating was moderate in 16 cases and severe in 46 cases. The sympathetic chain on the body of the second and third ribs in all patients was cauterized and divided; the chain on the fourth rib in those with axillary hyperhidrosis was also severed. Intraoperative changes in palmar temperature and blood flow were recorded.
Sympathectomies were successful, and dry limbs were immediately achieved in all patients after surgery. There were no mortality or life-threatening complication, however 1 patient developed moderate pneumothorax which resolved soon after chest drainage. After all procedures, palmar blood perfusion increased significantly and mean palmar temperature elevated by 2.4 degrees C. The mean operative duration was 65 min, and the mean postoperative hospital stay was 1.2 days. No recurrence of palmar hyperhidrosis occurred after a mean follow-up of 6.3 months (ranged from 1 to 13 months). Compensatory sweating was found in 26 patients, but the symptoms were mostly tolerable and required no further treatment.
Needlescopic thoracic sympathectomy is a safe and effective technique for palmar hyperhidrosis, which is less invasive than conventional video-assisted thoracic surgery.
评估针孔胸腔镜胸交感神经切除术治疗手掌多汗症的安全性和有效性。
2004年3月至2005年4月，62例患者接受了双侧针孔胸腔镜胸交感神经切除术，其中男性23例，女性39例，平均年龄23岁（12至53岁）。所有患者中8例伴有腋窝多汗症。手掌出汗程度为中度的有16例，重度的有46例。所有患者第二和第三肋骨体上的交感神经链均被烧灼切断；伴有腋窝多汗症的患者第四肋骨上的交感神经链也被切断。记录术中手掌温度和血流的变化。
交感神经切除术均成功，术后所有患者肢体立即变干。无死亡或危及生命的并发症发生，然而有1例患者出现中度气胸，胸腔引流后很快缓解。所有操作完成后，手掌血液灌注显著增加，平均手掌温度升高2.4℃。平均手术时间为65分钟，平均术后住院时间为1.2天。平均随访6.3个月（1至13个月）后，手掌多汗症无复发。26例患者出现代偿性出汗，但症状大多可耐受，无需进一步治疗。
针孔胸腔镜胸交感神经切除术是治疗手掌多汗症的一种安全有效的技术，其创伤比传统电视辅助胸腔手术小。
