Wolosker Nelson, Yazbek Guilherme, Milanez de Campos José Ribas, Kauffman Paulo, Ishy Augusto, Puech-Leão Pedro
Dept. of Vascular and Endovascular Surgery, Hospital das Clínicas School of Medicine, University of São Paulo, São Paulo, Brazil.
Clin Auton Res. 2007 Jun;17(3):172-6. doi: 10.1007/s10286-007-0420-5. Epub 2007 Jun 12.
Sympathectomy is the treatment of choice for primary hyperhidrosis. One curious occurrence that is difficult to explain from an anatomophysiological point of view in cases of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperhidrosis (PH) is the observed improvement in plantar hyperhidrosis (PLH). Nevertheless, current reports on VATS rarely describe the effect on PLH or just give superficial data. The aim of this study was to prospectively investigate, how surgery affects PLH in patients with PH and PLH over one-year period.
From May 2003 to January 2004, 70 consecutive patients with combined PH and PLH underwent VATS at the T2, T3, or T4 ganglion level (47 women and 23 men, with mean age of 23 years).
Immediately after the operation, all the patients said they were free from PH episodes, except for two patients (2.8%) who suffered from continued PH. Compensatory hyperhidrosis (CH) of various degrees was observed in 58 (90.6%) patients after one year. Only 13 (20.3%) suffered from severe CH. There was a great initial improvement in PLH in 50% of the cases, followed by progressive regression, such that only 23.4% still presented that improvement after one year. The number of cases without overall improvement increased progressively (from 17.1% to 37.5%) and the numbers with slight improvement remained stable (32.9-39.1%). Of the 24 patients with no improvement after one year, 6 patients graded plantar sweating worse.
Patients with PH and PLH who undergo VATS to treat their PH present a good initial improvement in PLH that reduces to a lower level of improvement after the one-year period.
交感神经切除术是原发性多汗症的首选治疗方法。在采用电视辅助胸腔镜交感神经切除术（VATS）治疗掌部多汗症（PH）的病例中，有一个奇怪的现象，从解剖生理学角度难以解释，即观察到足底多汗症（PLH）有所改善。然而，目前关于VATS的报道很少描述其对PLH的影响，或者只是给出表面数据。本研究的目的是前瞻性地调查手术如何在一年时间内影响PH和PLH患者的PLH。
2003年5月至2004年1月，70例合并PH和PLH的连续患者在T2、T3或T4神经节水平接受了VATS手术（47例女性和23例男性，平均年龄23岁）。
术后即刻，除2例患者（2.8%）仍有持续性PH外，所有患者均表示无PH发作。一年后，58例（90.6%）患者出现不同程度的代偿性多汗（CH）。只有13例（20.3%）患有严重CH。50%的病例中PLH最初有很大改善，随后逐渐消退，以至于一年后只有23.4%的病例仍有改善。总体无改善的病例数逐渐增加（从17.1%增至37.5%），轻度改善的病例数保持稳定（32.9 - 39.1%）。在一年后无改善的24例患者中，6例患者的足底出汗情况更差。
接受VATS治疗PH的PH和PLH患者，其PLH最初有良好改善，但一年后改善程度降低。
