Malmivaara Antti, Kuukasjärvi Pekka, Autti-Ramo Ilona, Kovanen Niina, Mäkelä Marjukka
Finnish Office for Health Technology Assessment, and Department of Physiatrics, University of Oulu, Box 8000, 90014 University of Oulu, Finland.
Int J Technol Assess Health Care. 2007 Winter;23(1):54-62. doi: 10.1017/S0266462307051574.
Despite controversies, endoscopic thoracic sympathectomy (ETS) has been used as a treatment for excessive sweating of hands and face and for facial blushing. This study aims to evaluate the effectiveness of ETS for the current indications in a systematic review.
Controlled clinical trials and cohort studies with more than 100 patients were included. Abstracts were searched from MEDLINE and CCTR from 1966 to June 2004. Two reviewers extracted the data and assessed study quality. Data on effectiveness and safety were synthesized qualitatively.
We did not find any controlled clinical trials. Fifteen prospective studies were included. The internal and external quality of these studies were poor overall. Follow-up was commonly less than 2 years, during which time excessive sweating and facial blushing seemed to decrease among most patients. Immediate complications related to thoracoscopy occurred in up to 10 percent of patients. Compensatory sweating below breast level was reported in up to 90 percent of the patients. Other common side effects included dryness of face and hands, gustatory sweating, and neuralgic pain. Several other less common side effects were reported.
The evidence of the effectiveness of ETS is weak due to a lack of randomized trials. The intervention leads to severe immediate complications in some of the patients, and to persistent side-effects for many of the patients.
尽管存在争议，内镜胸交感神经切除术（ETS）已被用于治疗手部和面部多汗症以及面部潮红。本研究旨在通过系统评价评估ETS对当前适应症的有效性。
纳入了100例以上患者的对照临床试验和队列研究。从1966年至2004年6月在MEDLINE和CCTR中检索摘要。两名研究者提取数据并评估研究质量。对有效性和安全性数据进行定性综合分析。
我们未找到任何对照临床试验。纳入了15项前瞻性研究。这些研究的内部和外部质量总体较差。随访时间通常少于2年，在此期间大多数患者的多汗症和面部潮红似乎有所减轻。高达10%的患者发生了与胸腔镜检查相关的即刻并发症。高达90%的患者报告了乳房水平以下的代偿性出汗。其他常见副作用包括面部和手部干燥、味觉性出汗和神经痛。还报告了其他几种不太常见的副作用。
由于缺乏随机试验，ETS有效性的证据不足。该干预措施在一些患者中导致严重的即刻并发症，在许多患者中导致持续的副作用。
