胸腔镜交感神经切断术与局部手术治疗腋窝多汗症的对比研究。
A comparative study of thoracoscopic sympathicotomy versus local surgical treatment for axillary hyperhidrosis.
机构信息
Department of Reconstructive and Plastic Surgery, Odense University Hospital, Odense, Denmark.
出版信息
Ann Thorac Surg. 2013 Jan;95(1):264-8. doi: 10.1016/j.athoracsur.2012.08.103. Epub 2012 Nov 29.
BACKGROUND
Axillary hyperhidrosis affects approximately 1.4% of the population. Medical management is often frustrating, and the response generally transient. Surgical methods include thoracoscopic sympathectomy or sympathicotomy and local axillary surgery such as suction-curettage or en-bloc skin resection. Many case series with retrospective follow-up are available in the literature, but no comparative studies between surgical techniques have been published.
METHODS
During a 9-year period, two groups of consecutive patients with isolated axillary hyperhidrosis underwent thoracoscopic sympathicotomy (n = 49) or local axillary surgery (n = 47) at the same university hospital, depending on referral or preference. Patients received identical questionnaires to investigate local effect and side effects after surgery.
RESULTS
Questionnaires were returned by 92% after a median of 26 months, with no significant difference between the two groups. Local effect was significantly better after axillary surgery compared with sympathicotomy (p < 0.001), but mild recurrent axillary symptoms were significantly more frequent after axillary surgery (51% versus 5%, p < 0.001). Compensatory and gustatory sweating were significantly more frequent after sympathicotomy (84% versus 25%, p < 0.001; and 54% versus 26%, p = 0.01, respectively).
CONCLUSIONS
Outcome after surgery for isolated axillary hyperhidrosis was significantly better after local surgical treatment compared with sympathicotomy. Local effect was better and side effects fewer, but milder recurrent symptoms were more frequent. Compensatory sweating also occurs after local axillary surgery and has not been reported before. Our results suggest that local axillary surgery is preferable for isolated axillary hyperhidrosis and that R2-R3 or R2-R4 sympathicotomy should be discouraged. Sympathicotomy should only be considered for patients who have additional palmar hyperhidrosis.
背景
腋窝多汗症影响约 1.4%的人群。医学治疗通常令人沮丧，且效果通常是短暂的。手术方法包括胸腔镜交感神经切除术或交感神经切断术以及局部腋窝手术，如抽吸刮除术或整块皮肤切除术。文献中有许多包含回顾性随访的病例系列，但没有发表过关于手术技术的比较研究。
方法
在 9 年期间，同一所大学医院的两组连续的单纯性腋窝多汗症患者根据转诊或偏好，分别接受胸腔镜交感神经切除术（n = 49）或局部腋窝手术（n = 47）。患者接受相同的问卷，以调查手术后的局部效果和副作用。
结果
在中位数为 26 个月后，92%的患者返回了问卷，两组之间没有显著差异。与交感神经切除术相比，局部手术后的局部效果明显更好（p < 0.001），但局部手术后轻度复发性腋窝症状明显更常见（51%对 5%，p < 0.001）。代偿性和味觉性出汗在交感神经切除术后明显更常见（84%对 25%，p < 0.001；54%对 26%，p = 0.01）。
结论
对于单纯性腋窝多汗症的手术治疗，与交感神经切除术相比，局部手术治疗的术后效果明显更好。局部效果更好，副作用更少，但轻度复发性症状更常见。局部腋窝手术后也会发生代偿性出汗，以前没有报道过。我们的结果表明，对于单纯性腋窝多汗症，局部腋窝手术是首选方法，应避免 R2-R3 或 R2-R4 交感神经切除术。仅应考虑对伴有手掌多汗症的患者进行交感神经切除术。
Zotero 插件