Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
Ann Thorac Surg. 2012 Aug;94(2):401-5. doi: 10.1016/j.athoracsur.2012.03.076. Epub 2012 May 24.
Facial blushing is one of the most peculiar of human expressions. The pathophysiology is unclear, and the prevalence is unknown. Thoracoscopic sympathectomy may cure the symptom and is increasingly used in patients with isolated facial blushing. The evidence base for the optimal level of targeting the sympathetic chain is limited to retrospective case studies. We present a randomized clinical trial.
100 patients were randomized (web-based, single-blinded) to rib-oriented (R2 or R2-R3) sympathicotomy for isolated facial blushing at two university hospitals during a 6-year period. Quality of life (QOL) was investigated preoperatively and after 12 months by Short Form 36. Local effects and side effects were assessed by questionnaire.
The male/female ratio was 27/73. The median age was 29 years (range, 18-56 years. The response rate was 93%. QOL increased significantly in all social and mental domains in both groups. Overall, 85% of the patients had an excellent or satisfactory result, with no significant difference between the R2 procedure and the R2-R3 procedure. Mild recurrence of facial blushing occurred in 30% of patients within the first year. One patient experienced Horner's syndrome. Compensatory sweating occurred in 93% of patients, gustatory sweating 36%, and dry hands in 66%; 13% of patients regretted the operation despite thorough preoperative selection and information.
There were no significant differences in local effects or side effects between R2 and R2-R3 sympathicotomy for isolated facial blushing. Both were effective, and QOL increased significantly. Despite very frequent side effects, the vast majority of patients were satisfied. Surprisingly, many patients experienced mild recurrent symptoms within the first year; this should always be discussed with patients preoperatively.
面部潮红是人类最奇特的表情之一。其病理生理学机制尚不清楚，患病率也不清楚。胸腔镜交感神经切除术可能治愈该症状，并且越来越多地用于治疗孤立性面部潮红的患者。交感神经链靶向最佳水平的证据仅限于回顾性病例研究。我们进行了一项随机临床试验。
在两所大学医院的 6 年期间，100 例孤立性面部潮红患者被随机（基于网络的单盲）分为肋骨定向（R2 或 R2-R3）交感神经切除术组。术前和术后 12 个月通过 36 项简短形式健康调查量表（Short Form 36）调查生活质量（QOL）。通过问卷调查评估局部效果和副作用。
男女比例为 27/73。中位年龄为 29 岁（范围 18-56 岁）。应答率为 93%。两组患者所有社会和心理领域的 QOL 均显著提高。总体而言，85%的患者对手术结果非常满意或满意，R2 手术和 R2-R3 手术之间无显著差异。30%的患者在术后 1 年内出现轻度面部潮红复发。1 例患者出现霍纳综合征。93%的患者出现代偿性出汗，36%出现味觉性出汗，66%出现手部干燥；尽管术前进行了彻底的选择和信息告知，但仍有 13%的患者对手术后悔。
孤立性面部潮红的 R2 和 R2-R3 交感神经切除术之间局部效果和副作用无显著差异。两种方法均有效，且 QOL 显著提高。尽管副作用非常常见，但绝大多数患者仍满意。令人惊讶的是，许多患者在术后 1 年内出现轻度复发性症状；术前应与患者讨论这一问题。
