Awad Mohamed Salah, Elzeftawy Awny, Mansour Salah, Elshelfa Wael
Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt.
J Minim Access Surg. 2010 Jan;6(1):11-5. doi: 10.4103/0972-9941.62529.
Thoracoscopic sympathetic surgery is currently the best treatment for hyperhidrosis, and the success rate is quite high, but poor emphasis has been given to the type of anaesthesia and its application through either one or two stages of surgery. This study has evaluated the operative and postoperative results of one-stage bilateral thoracoscopic sympathectomy under local anaesthesia.
From 2003 to 2007, n=14 patients with hyperhidrosis of the upper limbs [4 females and 10 males] with a mean age of 28+/-2.11 year [range 26-44] were included. They were operated on by means of bilateral ETS under local anaesthesia. The mean follow-up was 1.5 years (range 13-24 months).
No operative mortality was recorded. The mean operating room time for the whole bilateral procedure under was 73. 5+/-14.5 range [60 -120] min most of the patients were discharged the same day after a chest roentgenogram except, only two patients with gustatory sweating one recurrent sweating in the patient who had previously axillary hyperhidrosis. Also among them two patients (20%) experienced a minimal pneumothorax that required no treatment. Postoperative quality of life and satisfaction were excellent and cost was significantly reduced.
Bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed in patients refusing GA regarding cost and satisfaction.
胸腔镜交感神经手术是目前治疗多汗症的最佳方法，成功率相当高，但对于麻醉类型及其在一期或二期手术中的应用重视不足。本研究评估了局部麻醉下一期双侧胸腔镜交感神经切除术的手术及术后结果。
纳入2003年至2007年的14例上肢多汗症患者[4例女性，10例男性]，平均年龄28±2.11岁[范围26 - 44岁]。他们接受了局部麻醉下的双侧胸交感神经链切断术（ETS）。平均随访时间为1.5年（范围13 - 24个月）。
无手术死亡记录。双侧手术的平均手术室时间为73.5±14.5分钟[范围60 - 120分钟]，除了2例味觉性出汗患者和1例既往有腋窝多汗症的患者出现复发性出汗外，大多数患者在胸部X线检查后当天出院。其中还有2例患者（20%）出现轻微气胸，无需治疗。术后生活质量和满意度极佳，费用显著降低。
对于拒绝全身麻醉（GA）的患者，就费用和满意度而言，双侧胸腔镜交感神经切除术治疗手掌多汗症可安全有效地进行。
