Department of Surgical Pathology, University of Sassari, Viale San Pietro 43b, 07100, Sassari, Italy.
Clin Auton Res. 2011 Apr;21(2):97-102. doi: 10.1007/s10286-010-0110-6. Epub 2011 Jan 19.
To evaluate and compare the immediate and long-term outcomes of videothoracoscopic T2-T4 sympathectomy and T3-T4 sympathicotomy for the treatment of palmar and axillary hyperhidrosis.
Between October 1993 and September 2007, we treated a total of 88 patients affected by palmar and axillary hyperhidrosis. Twenty-four patients underwent T2-T4 sympathectomy with 5-10 mm trocars (Group A), 43 T2-T4 sympathectomy with 2-5 mm trocars (Group B), 15 T3-T4 sympathicotomy with 5-10 mm trocars and 6 T3-T4 ganglion block with 2-5 mm trocars (Group C). The mean operative time, for each side, was 15 min for sympathicotomy and 28 min for sympathectomy. In September 2008, we recontacted 98% of patients (total 86), by telephone, to establish long-term results (follow-up range 1-15 years).
In this series, we did not find any significant difference between T2-T4 sympathectomy and T3-T4 sympathicotomy in terms of postsurgical palmar anhidrosis or onset of compensatory hyperhidrosis, while both methods show high efficacy for remission of palmar hyperhidrosis. The slightly higher recurrence rate in our early experience (Group A) can be attributed to the learning curve. Using smaller trocars (2-5 mm), we reduced postsurgical intercostal pain and obtained better aesthetic results and a higher grade of patient's satisfaction.
Thoracoscopic approach to hyperhidrosis has evolved in the last few decades with a consequent decrease in side effects. In this series, all patients experienced an improvement in quality of life even in case of recurrence or onset of compensatory hyperhidrosis. Due to these results, the shorter operative time and easier performance of sympathicotomy, we prefer this method.
评估并比较胸腔镜 T2-T4 交感神经切除术和 T3-T4 交感神经切断术治疗手掌和腋窝多汗症的即刻和长期疗效。
1993 年 10 月至 2007 年 9 月，我们共治疗了 88 例手掌和腋窝多汗症患者。24 例行 T2-T4 交感神经切除术，使用 5-10mm 套管（A 组）；43 例行 T2-T4 交感神经切除术，使用 2-5mm 套管（B 组）；15 例行 T3-T4 交感神经切断术，使用 5-10mm 套管；6 例行 T3-T4 交感神经节阻滞术，使用 2-5mm 套管（C 组）。每侧手术的平均时间为交感神经切断术 15 分钟，交感神经切除术 28 分钟。2008 年 9 月，我们通过电话联系了 98%的患者（共 86 例），以确定长期结果（随访范围 1-15 年）。
在本系列中，我们没有发现 T2-T4 交感神经切除术和 T3-T4 交感神经切断术在术后手掌无汗或代偿性多汗发作方面有显著差异，两种方法对缓解手掌多汗症均有很高的疗效。我们早期经验（A 组）中稍高的复发率可归因于学习曲线。使用较小的套管（2-5mm），我们减轻了术后肋间疼痛，并获得了更好的美容效果和更高的患者满意度。
胸腔镜治疗多汗症在过去几十年中得到了发展，因此副作用也相应减少。在本系列中，所有患者的生活质量都得到了改善，即使出现复发或代偿性多汗。由于这些结果，交感神经切断术的手术时间更短，操作更简单，我们更倾向于这种方法。
