Steiner Zvi, Kleiner Oleg, Hershkovitz Yehuda, Mogilner Jorge, Cohen Zahavi
Department of Pediatric Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel.
J Pediatr Surg. 2007 Jul;42(7):1238-42. doi: 10.1016/j.jpedsurg.2007.02.015.
BACKGROUND/PURPOSE: Palmar hyperhidrosis is a fairly common condition that is treatable by thoracoscopic sympathectomy (TS). Compensatory sweating (CS) is a major side effect of TS. We surveyed post-TS patients to determine the procedure's long-term success, satisfaction, complications, the natural history of CS, and whether those with CS would still have undergone the procedure.
A chart review of all patients who had undergone TS at 2 medical centers yielded 621 patients (mean age, 16.1 years) with a follow-up of more than 24 months: 265 (43%) could be contacted and agreed to reply to a detailed telephone questionnaire.
Most participants (97%) reported complete (89.4%) or reasonable (7.6%) symptomatic relief. The long-term postoperative satisfaction was high (84.5%). Forty-one percent of the participants claimed that their quality of life decreased moderately or severely as a result of CS. Only 19.6% would not have undergone the operation in retrospect; there was a significant interesting difference regarding this issue between adults (31.4%) and children (8.8%). The extent of the CS did not change with time in 70% of the patients. It exacerbated in 10% and it diminished in 20%, usually within the first 2 postoperative years.
Thoracoscopic sympathectomy relieves hyperhidrosis in most cases. Patients prefer relief from palmar hyperhidrosis even at the cost of a high rate of CS. Hyperhidrosis is not a self-limiting condition, and we recommend not postponing TS until adulthood.
背景/目的：手掌多汗症是一种相当常见的病症，可通过胸腔镜交感神经切除术（TS）进行治疗。代偿性出汗（CS）是TS的主要副作用。我们对接受TS治疗后的患者进行了调查，以确定该手术的长期成功率、满意度、并发症、CS的自然病程，以及患有CS的患者是否仍会接受该手术。
对两家医疗中心所有接受TS治疗的患者进行病历回顾，共纳入621例患者（平均年龄16.1岁），随访时间超过24个月：其中265例（43%）能够取得联系并同意回复详细的电话调查问卷。
大多数参与者（97%）报告症状完全缓解（89.4%）或有所缓解（7.6%）。术后长期满意度较高（84.5%）。41%的参与者称，由于CS，他们的生活质量有中度或重度下降。只有19.6%的人回顾时表示不会接受该手术；在这个问题上，成人（31.4%）和儿童（8.8%）之间存在显著差异。70%的患者CS程度未随时间变化。10%的患者CS加重，20%的患者CS减轻，通常在术后头两年内。
胸腔镜交感神经切除术在大多数情况下可缓解多汗症。患者宁愿忍受手掌多汗症的缓解，即使以高比例的CS为代价。多汗症不是一种自限性疾病，我们建议不要将TS推迟到成年期。
