Vanderhelst Eef, De Keukeleire Tom, Verbanck Sylvia, Vincken Walter, Noppen Marc
Respiratory Division, University Hospital Brussels UZB, Brussels, Belgium.
J Laparoendosc Adv Surg Tech A. 2011 Dec;21(10):905-9. doi: 10.1089/lap.2011.0258. Epub 2011 Oct 19.
Essential hyperhidrosis (EH) is defined as excessive functioning of the sudomotor sweat system. Definitive treatment of choice is video-assisted thoracoscopic sympathetic interruption. Success rates are high, but compensatory hyperhidrosis (CH) remains a troublesome side effect. The aim of this study was to document patient satisfaction and side effects at least 6 months after thoracoscopic sympathicolysis.
Between 2001 and 2005, 246 patients underwent bilateral ablation of the sympathetic chain at the thoracic level T2, T3, and/or T4. Questionnaires using open questions and scoring systems were sent at least 6 months after procedure and were returned by 138 patients (56%).
From the 138 patients (56 males/82 females), 39 suffered from cranial (±facial blushing), 34 from palmar, and 34 from axillary hyperhidrosis. Thirty-one patients were treated for a combination. No conversion to open surgery or deaths occurred. For the whole group, average quality of life was 4.5±2.5 before and 8.4±1.8 after surgery (P<.001). Ninety-one percent were very satisfied (score ≥7) and 80% showed an increased quality of life of ≥2. Compensatory sweating occurred in 76% of the patients, only 6% reported this as disabling. Comparing subgroups, a significant improvement in primary complaint score was found in 90%, 94%, and 91% for the T2, T3, and T4 patients, respectively. In the T4 group, the prevalence of CH was markedly lower (53%) and none of these patients were dissatisfied.
Thoracoscopic ablation of the sympathetic chain is an effective treatment for EH; CH occurs in the majority of patients, but only rarely impairs postoperative quality of life.
原发性多汗症（EH）被定义为汗腺分泌系统功能亢进。明确的首选治疗方法是电视辅助胸腔镜交感神经切断术。成功率很高，但代偿性多汗（CH）仍然是一个棘手的副作用。本研究的目的是记录胸腔镜交感神经溶解术后至少6个月患者的满意度和副作用。
2001年至2005年期间，246例患者在胸段T2、T3和/或T4水平进行了双侧交感神经链消融术。术后至少6个月发送了使用开放式问题和评分系统的问卷，138例患者（56%）回复。
138例患者（56例男性/82例女性）中，39例患有头部（±面部潮红）多汗症，34例患有手掌多汗症，34例患有腋窝多汗症。31例患者接受了联合治疗。未发生转为开放手术或死亡情况。对于整个组，术前平均生活质量为4.5±2.5，术后为8.4±1.8（P<0.001）。91%的患者非常满意（评分≥7），80%的患者生活质量提高≥2。76%的患者出现代偿性出汗，只有6%的患者称其致残。比较亚组，T2、T3和T4患者的主要症状评分分别有90%、94%和91%有显著改善。在T4组中，CH的发生率明显较低（53%），且这些患者均无不满。
胸腔镜下交感神经链消融术是治疗EH的有效方法；大多数患者会出现CH，但很少影响术后生活质量。
