Rieger R, Pedevilla S, Pöchlauer S
Abteilung für Chirurgie, Landeskrankenhaus Gmunden, eine Gesundheitseinrichtung der Gespag, Gmunden, Osterreich.
Chirurg. 2008 Dec;79(12):1151-61. doi: 10.1007/s00104-008-1560-4.
Thoracic sympathectomy is a valuable treatment option for patients with primary hyperhidrosis. However, controversies exist about the optimal technique of sympathectomy and the association between localisation of the focal hyperhidrosis and postoperative results.
Retrospective analysis was performed on prospectively collected data of 402 thoracic sympathectomies performed in 204 consecutive patients with palmar-plantar (n=123), palmar-axillary (34), isolated axillary (35), and craniofacial (12) hyperhidrosis. The standard procedure was video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4/5.
All procedures were performed thoracoscopically without serious perioperative complications. Postoperative morbidity was 2.5% (10/402) including two cases of incomplete Horner's syndrome (0.5%). One hundred forty-three patients were followed for a mean of 21 months (6-86). Palmar hyperhidrosis was eliminated in 100% of cases and axillary hyperhidrosis in 98.5%. There were three axillary recurrences (1.5%). Of all patients, 60% suffered from transient postsympathectomy neuralgia which was mild in the majority of cases. Strong compensatory sweating occurred in 17% of patients with palmar-plantar and palmar-axillary hyperhidrosis and in 53% of patients with isolated axillary hyperhidrosis (P<0.001). In the palmar-plantar and palmar-axillary groups, 92% were very satisfied with the postoperative results, 90% reported increased quality of life, and 93% would repeat the operation. The corresponding numbers in patients with isolated axillary hyperhidrosis were 47%, 44%, and 66%, respectively (P<0.001).
Video-assisted thoracoscopic resection of the sympathetic chain from T2 to T4-5 is safe and effective and leads in almost 100% of cases to the elimination of palmar and axillary hyperhidrosis. In contrast to the excellent results in patients with palmar-plantar and palmar-axillary hyperhidrosis, outcome in patients with isolated axillary hyperhidrosis was impaired by a high rate of disturbing compensatory sweating.
胸交感神经切除术是原发性多汗症患者的一种有价值的治疗选择。然而，关于交感神经切除术的最佳技术以及局灶性多汗症的定位与术后结果之间的关联存在争议。
对204例连续性掌跖（n = 123）、掌腋（34）、单纯腋窝（35）和颅面（12）多汗症患者进行的402例胸交感神经切除术的前瞻性收集数据进行回顾性分析。标准手术是电视辅助胸腔镜下切除T2至T4/5的交感神经链。
所有手术均通过胸腔镜进行，无严重围手术期并发症。术后发病率为2.5%（10/402），包括2例不完全性霍纳综合征（0.5%）。143例患者平均随访21个月（6 - 86个月）。掌部多汗症在100%的病例中消除，腋窝多汗症在98.5%的病例中消除。有3例腋窝复发（1.5%）。所有患者中，60%患有短暂性交感神经切除术后神经痛，大多数病例症状较轻。17%的掌跖和掌腋多汗症患者以及53%的单纯腋窝多汗症患者出现强烈的代偿性出汗（P<0.001）。在掌跖和掌腋组中，92%对术后结果非常满意，90%报告生活质量提高，93%愿意再次手术。单纯腋窝多汗症患者的相应比例分别为47%、44%和66%（P<0.001）。
电视辅助胸腔镜下切除T2至T4 - 5的交感神经链安全有效，几乎在100%的病例中可消除掌部和腋窝多汗症。与掌跖和掌腋多汗症患者的良好结果相反，单纯腋窝多汗症患者的结局因高比例的令人困扰的代偿性出汗而受损。
