Miller Daniel L, Force Seth D
Section of General Thoracic Surgery, Department of General Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Ann Thorac Surg. 2008 Apr;85(4):1211-4; discussion 1215-6. doi: 10.1016/j.athoracsur.2007.11.020.
Compensatory hyperhidrosis (CH) is the most common side effect after a thoracoscopic sympathectomy. The fear of CH is the most common reason why patients do not undergo a sympathectomy, because it is an irreversible procedure unless removal clips are used. Unfortunately, clip removal for reversal of postsympathectomy CH has not been reliable. To address this issue, we developed a new technique of a temporary thoracoscopic sympathetic block that can hopefully predict if postsympathectomy CH is going to occur after sympathectomy for medical refractory primary hyperhidrosis (PH).
We reviewed all patients who underwent a temporary thoracoscopic sympathetic block and subsequent thoracoscopic sympathectomy for medical refractory PH. All patients were concerned about the development of CH and requested the possibility of a reversible procedure.
Twenty-five patients underwent a temporary thoracoscopic sympathetic block; 18 suffered from palmar, axillary, and plantar hyperhidrosis, 4 had axillary and plantar hyperhidrosis; and 3 had palmar and plantar hyperhidrosis. The sympathetic block and subsequent sympathectomy were performed as outpatient bilateral thoracoscopic procedures. Sympathetic blockade was performed at each level of the planned sympathectomy (T2, T3, and accessory nerves) with 2.5 cc 0.25% marcaine with epinephrine per level without complications. All patients had temporary relief of hyperhidrosis ranging from 1 to 10 days with a median of 4 days after the block. Three patients (12%) had temporary CH after the thoracoscopic block, 2 mild and 1 severe. All but 1 (4%), the severe CH patient, elected to proceed with the planned sympathectomy; all sympathectomy patients (100%) were cured of their excessive sweating. The 2 patients who experienced mild CH after the thoracoscopic block also had it after the sympathectomy. All patients were completely satisfied with the final results, even the 2 patients in whom mild CH developed.
Temporary thoracoscopic sympathetic block is a reversible and accurate procedure for the determination of postsympathectomy CH. A temporary thoracoscopic sympathetic block followed by sympathectomy may be the best approach for the treatment of medically refractory PH in patients who are concerned about the development of postsympathectomy CH.
代偿性多汗症（CH）是胸腔镜交感神经切除术后最常见的副作用。对CH的恐惧是患者不接受交感神经切除术的最常见原因，因为除非使用移除夹，否则这是一个不可逆的手术。不幸的是，用于逆转交感神经切除术后CH的夹移除并不可靠。为了解决这个问题，我们开发了一种新的临时胸腔镜交感神经阻滞技术，有望预测在因难治性原发性多汗症（PH）进行交感神经切除术后是否会发生CH。
我们回顾了所有接受临时胸腔镜交感神经阻滞及随后因难治性PH进行胸腔镜交感神经切除术的患者。所有患者都担心CH的发生，并要求进行可逆手术。
25例患者接受了临时胸腔镜交感神经阻滞；18例患有手掌、腋窝和足底多汗症，4例患有腋窝和足底多汗症；3例患有手掌和足底多汗症。交感神经阻滞及随后的交感神经切除术作为门诊双侧胸腔镜手术进行。在计划交感神经切除术的每个水平（T2、T3和副神经）进行交感神经阻滞，每水平注射2.5毫升含肾上腺素的0.25%布比卡因，无并发症。所有患者在阻滞后多汗症均有1至10天的临时缓解，中位缓解时间为4天。3例患者（12%）在胸腔镜阻滞后出现临时CH，2例轻度，1例重度。除1例（4%）重度CH患者外，所有患者均选择进行计划中的交感神经切除术；所有交感神经切除术患者（100%）的多汗症均得到治愈。2例在胸腔镜阻滞后出现轻度CH的患者在交感神经切除术后也出现了CH。所有患者对最终结果都非常满意，即使是出现轻度CH的2例患者。
临时胸腔镜交感神经阻滞是一种用于确定交感神经切除术后CH的可逆且准确的方法。对于担心交感神经切除术后CH发生的难治性PH患者，先进行临时胸腔镜交感神经阻滞，然后进行交感神经切除术可能是最佳治疗方法。
