Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Branch St. 10#, Yuzhong District, Chongqing City, 400042, People's Republic of China.
Surg Endosc. 2011 Jun;25(6):1893-901. doi: 10.1007/s00464-010-1482-3. Epub 2010 Dec 7.
The systemic review and meta-analysis of the studies published during the past 10 years was designed to optimize the surgical procedures of video-assisted thoracoscopic sympathectomy (VTS) to treat palmar hyperhidrosis (PH).
Citations from 2000 to 2010 were included regarding the following aspects: selection of ganglia level for VTS, comparison of different techniques for VTS, evaluating clinical efficacy of intraoperative intrapleural analgesia, and postoperative intrapleural drainage. Major clinical outcomes are defined as: cases with postoperative resolution of symptoms, total cases with postoperative compensatory hyperhidrosis (CH), cases with severe or moderate CH, satisfied cases, evaluation of postoperative pain, and postoperative pneumothorax.
Systemic review indicates that T3 and T3-4 sympathectomy had the "best" clinical efficacy. Meta-analysis suggests that efficacious rates of PH are nearly similar compared with multiple and single ganglia sympathectomy (100 vs. 95.6%). However, single-ganglia sympathectomy can render a lower risk of total CH compared with multiple-ganglia block. Risk of moderate/severe CH has a similar trend. Additionally, single-ganglia sympathectomy is more potent to satisfy patients postoperatively. One randomized, controlled trial (RCT) that compared different techniques for VTS indicated that the overall success rate of the operation was 95% and the differences were not statistically significant. Two RCTs indicated that there were significant differences between trial group (intraoperative intercostal nerve blocks using bupivacaine) and control group regarding the attenuation of postoperative pain. One RCT suggested that there was no significant difference with or without pleural drainage regarding the incidence of postoperative residual pneumothorax.
T3 sympathectomy is supposed to be recommended for the treatment of PH regardless of using various techniques. Intraoperative intrapleural analgesia using bupivacaine or bupivacaine plus epinephrine is effective to prevent postoperative pain. Pleural drainage after VTS should be abandoned.
对过去 10 年发表的研究进行系统回顾和荟萃分析，旨在优化胸腔镜交感神经切断术（VTS）治疗手掌多汗症（PH）的手术程序。
纳入 2000 年至 2010 年期间有关以下方面的文献：VTS 时交感神经节水平的选择、不同 VTS 技术的比较、术中胸腔内镇痛的临床疗效评估以及术后胸腔内引流。主要临床结果定义为：术后症状缓解的病例、术后代偿性多汗（CH）的总病例、严重或中度 CH 的病例、满意的病例、术后疼痛评估和术后气胸。
系统评价表明 T3 和 T3-4 交感神经切断术具有“最佳”的临床疗效。荟萃分析表明，PH 的有效率与多节和单节交感神经切断术相似（100 与 95.6%）。然而，与多节神经阻断相比，单节神经切断术可降低总 CH 的风险。中度/重度 CH 的风险也有类似的趋势。此外，单节交感神经切断术术后更能满足患者的需求。一项比较 VTS 不同技术的随机对照试验（RCT）表明，手术的总体成功率为 95%，差异无统计学意义。两项 RCT 表明，在术后疼痛缓解方面，试验组（使用布比卡因肋间神经阻滞）与对照组之间存在显著差异。一项 RCT 表明，胸腔引流与否对术后残余气胸的发生率无显著差异。
无论采用何种技术，T3 交感神经切断术均应推荐用于治疗 PH。术中使用布比卡因或布比卡因加肾上腺素进行胸腔内镇痛可有效预防术后疼痛。VTS 后应放弃胸腔引流。
