Department of Surgery, Division of Surgery and Cancer, Imperial College, London W2 1NY, United Kingdom.
Int J Surg. 2011;9(5):437-9. doi: 10.1016/j.ijsu.2011.04.006. Epub 2011 Apr 22.
To evaluate the long-term results of thoracoscopic sympathectomy in the treatment of hyperhydrosis.
Theatre log books were used to identify all patients who underwent thoracoscopic sympathectomy between 2000 and 2006. Details of pre-operative symptoms, surgical procedure and post-operative complications were collected from the patient notes. Each patient was sent a questionnaire regarding success of the procedure, compensatory sweating and overall satisfaction.
46 hyperhydrosis patients (34 females) age range 14-57 years. 20 patients suffered with hyperhydrosis in a combination of areas, 14 in the axillae alone, 9 palms alone and with 2 facial symptoms. There were 2 early post-operative complications, 1 haemothorax which required a chest drain and a chest infection. 3 patients required redo procedures. Of follow-up of 42 months (range 6-84), 32 (69·5%) patients reported complete dryness or a significant improvement in symptoms and 15 a substantial improvement in quality of life. However 43 patients (93%) suffered with compensatory sweating, of these 27 had to change clothes more than once daily. Compensatory sweating was graded as severe in 18 and incapacitating in 2. Of note only 5 patients noticed an improvement in the compensatory sweating over time. Only 26 (56%) would recommend thoracoscopic sympathectomy to others with hyperhydrosis.
Thoracoscopic sympathectomy is effective in the treatment of hyperhydrosis. However compensatory sweating seems unavoidable and infrequently improves with time. Patients need to be carefully counselled before committing to surgery.
评估胸腔镜交感神经切除术治疗多汗症的长期效果。
使用手术日志本确定 2000 年至 2006 年间接受胸腔镜交感神经切除术的所有患者。从病历中收集术前症状、手术过程和术后并发症的详细信息。向每位患者发送一份关于手术成功率、代偿性出汗和总体满意度的调查问卷。
46 例多汗症患者（34 名女性）年龄 14-57 岁。20 例患者在多个部位出现多汗症，14 例仅在腋窝，9 例仅在手掌，并有 2 例面部症状。有 2 例术后早期并发症，1 例血胸需引流，1 例胸部感染。3 例患者需要再次手术。42 个月（6-84 个月）的随访中，32 例（69.5%）患者报告完全干燥或症状明显改善，15 例患者生活质量显著改善。然而，43 例（93%）患者出现代偿性出汗，其中 27 例需要每天换衣服不止一次。代偿性出汗在 18 例中评为严重，在 2 例中评为致残。值得注意的是，只有 5 例患者注意到代偿性出汗随时间的改善。只有 26 例（56%）患者会向其他多汗症患者推荐胸腔镜交感神经切除术。
胸腔镜交感神经切除术治疗多汗症有效。然而，代偿性出汗似乎不可避免，且随时间改善的情况很少见。在进行手术前，患者需要仔细咨询。
