Bachmann Kai, Standl Nicola, Kaifi Jussuf, Busch Phillip, Winkler Eva, Mann Oliver, Izbicki Jakob R, Strate Tim
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Surg Endosc. 2009 Jul;23(7):1587-93. doi: 10.1007/s00464-009-0392-8. Epub 2009 Mar 4.
During recent years, thoracoscopic sympathectomy has been the standard treatment for hyperhidrosis. Different surgical techniques have been described without proving their advantages compared with other procedures. This study was designed to evaluate our modification of thoracoscopic sympathectomy and to compare the effectiveness between axillary and palmar hyperhidrosis.
Ninety patients with axillary or palmar hyperhidrosis who underwent bilateral thoracoscopic sympathectomy with single-lumen ventilation with a dual 5-mm port approach were followed up for a median of 3.9 (range, 1-6) years. The clinical course and data during the hospitalization and consultation in our outpatient clinic were reviewed. The following parameters were evaluated: clinical improvement, satisfaction, changes in quality of life, and compensatory sweating and gustatory sweating.
The perioperative mortality was 0, and the morbidity was 6.5%. In 81% clinical improvement of sweating was noticed; 55% did not sweat at all. A total of 88% of patients were satisfied with the result of the operation. The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively. The result of sympathectomy in patients with palmar hyperhidrosis were significantly better concerning rate of satisfaction (p = 0.006) and improvement of symptoms (p = 0.027) compared with patients with axillary symptoms. Additionally it was found that the compensatory sweating had significantly impacted the satisfaction rating of the operation.
Currently different effective surgical approaches for the treatment of hyperhidrosis with improvement rates of more than 80% are available. The quality of the intervention has to be evaluated by changes in quality of life and intensity of compensatory sweating. Thoracoscopic sympathectomy as performed in our institution offers results and complications comparable to previously published trials; however, because of single-lumen ventilation the management is much easier. Therefore, this technique offers an interesting option for the treatment of patients with palmar and axillary hyperhidrosis.
近年来，胸腔镜交感神经切除术一直是多汗症的标准治疗方法。已经描述了不同的手术技术，但与其他手术相比，尚未证明其优势。本研究旨在评估我们对胸腔镜交感神经切除术的改良，并比较腋窝多汗症和手掌多汗症之间的治疗效果。
90例腋窝或手掌多汗症患者接受了双侧胸腔镜交感神经切除术，采用单腔通气和双5毫米端口入路，中位随访时间为3.9年（范围1 - 6年）。回顾了患者在住院期间以及在我们门诊咨询时的临床病程和数据。评估了以下参数：临床改善情况、满意度、生活质量变化、代偿性出汗和味觉性出汗。
围手术期死亡率为0，发病率为6.5%。81%的患者出汗情况有临床改善；55%的患者完全不出汗。共有88%的患者对手术结果满意。代偿性出汗和味觉性出汗的发生率分别为93.5%和49.4%。与腋窝多汗症患者相比，手掌多汗症患者交感神经切除术的结果在满意度（p = 0.006）和症状改善（p = 0.027）方面明显更好。此外，发现代偿性出汗对手术满意度评分有显著影响。
目前有多种有效的手术方法可用于治疗多汗症，改善率超过80%。干预质量必须通过生活质量的变化和代偿性出汗的强度来评估。我们机构进行的胸腔镜交感神经切除术的结果和并发症与先前发表的试验相当；然而，由于采用单腔通气，管理更加容易。因此，该技术为治疗手掌和腋窝多汗症患者提供了一个有吸引力的选择。
