Assalia Ahmad, Bahouth Hany, Ilivitzki Anat, Assi Zaki, Hashmonai Moshe, Krausz Michael M
Department of Surgery B, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
World J Surg. 2007 Oct;31(10):1976-9; discussion 1980-1. doi: 10.1007/s00268-007-9160-x.
Upper dorsal sympathectomy is the only successful therapeutic method for idiopathic palmar hyperhidrosis (IPHH). However, the techniques for sympathetic ablation are still debated. The aim of this study was to compare prospectively two accepted methods for endoscopic sympathetic ablation: resection of T2-T3 ganglia versus transection of the chain over the second to fourth ribs. During the period September 2000 to June 2002, a total of 32 patients with IPHH were operated on. Operations were performed under general anesthesia through two 5-mm trocars using electrocautery. Resection was done on one side and transection on the other, with both sides being addressed during the same operation. The sides of resection/transection were alternated at each operation. There were 14 men and 18 women aged 18.8 +/- 4.7 years. The mean operating times for sympathectomy were 12.0 +/- 3.1 minutes for resection and 6.6 +/- 1.9 minutes for transection (p = 1.38). All patients were examined at 2 weeks postoperatively and again at 1 month. During November-December 2005, patients were approached by telephone questionnaire, the mean follow-up period being 4.3 +/- 0.9 years. Altogether, 26 of the 32 patients could be located (15 women, 11 men). There was no significant difference with regards to perioperative complications, immediate or long-term pain. All but two hands were warm and dry 1 month after operation and remained so at follow-up. The exceptions included one hand with recurrent hyperhidrosis after 1.5 years and one that became less dry and cold at 3 years. Both were on the transected sides. Our results suggest that sympathetic resection may achieve slightly better long-term results than transection in patients with IPHH. Large-scale prospective studies are needed to confirm these results.
上胸段交感神经切除术是治疗特发性掌部多汗症（IPHH）唯一成功的治疗方法。然而，交感神经消融技术仍存在争议。本研究的目的是前瞻性比较两种公认的内镜下交感神经消融方法：切除T2-T3神经节与横断第二至第四肋骨水平的交感神经链。在2000年9月至2002年6月期间，共有32例IPHH患者接受了手术。手术在全身麻醉下通过两个5毫米的套管针使用电灼进行。一侧进行切除，另一侧进行横断，两侧在同一次手术中处理。每次手术时切除/横断的侧别交替进行。患者共14名男性和18名女性，年龄为18.8±4.7岁。交感神经切除术的平均手术时间，切除组为12.0±3.1分钟，横断组为6.6±1.9分钟（p = 1.38）。所有患者在术后2周和1个月时进行检查。在2005年11月至12月期间，通过电话问卷对患者进行随访，平均随访时间为4.3±0.9年。总共找到了32例患者中的26例（15名女性，11名男性）。围手术期并发症、即时或长期疼痛方面无显著差异。术后1个月时，除两只手外，其余所有手均温暖干燥，并在随访时保持如此。例外情况包括1只手在1.5年后出现复发性多汗症，另1只手在3年后变得不那么干燥和冰冷。这两只手均在横断侧。我们的结果表明，对于IPHH患者，交感神经切除术可能比横断术取得稍好一点的长期效果。需要大规模的前瞻性研究来证实这些结果。
