Department of Cardiothoracic Surgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, 350001, China.
Surg Endosc. 2013 Jun;27(6):2149-55. doi: 10.1007/s00464-012-2732-3. Epub 2013 Jan 26.
The newest trend in the field of thoracic surgery, thoracic natural orifice transluminal endoscopic surgery (NOTES), is still in the early stages of development and limited to animal experiments. Transumbilical endoscopic surgery could work as a viable intermediate step before pure NOTES. We describe our experiences performing transumbilical-diaphragmatic thoracic sympathectomy with an ultrathin flexible endoscope for palmar and axillary hyperhidrosis in human patients.
From April 2010 to January 2012, a total of 38 patients underwent transumbilical-diaphragmatic thoracic sympathectomy. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. An ultrathin endoscope was introduced through the long trocar and then passed through the rigid incision made in the left and right diaphragm and into the thoracic cavity. The ganglion was ablated at the desired thoracic level.
Sympathectomy was performed successfully in all patients. Mean operation time was 68 ± 16 (range, 48-107) minutes. There was no mortality and no conversion to open surgery during the operation of any patient. At a median follow-up of 11 (range, 4-12) months after surgery, no diaphragmatic hernia was observed. The rate of palmar hyperhidrosis and axillary hyperhidrosis resolution was 100 and 75 %, respectively.
Transumbilical endoscopic thoracic sympathectomy is technically feasible and safe, which has the possible advantages of pure NOTES and can be performed in routine clinical practice.
胸外科领域的最新趋势——经自然腔道内镜手术（NOTES）仍处于发展初期，仅限于动物实验。经脐内镜手术可能是纯NOTES 之前的可行中间步骤。我们描述了我们在人类患者中使用超纤细柔性内镜进行经脐膈肌胸腔交感神经切除术治疗手掌和腋窝多汗症的经验。
从 2010 年 4 月至 2012 年 1 月，共有 38 例患者接受了经脐膈肌胸腔交感神经切除术。通过脐部切口，插入新开发的长穿刺器进入腹腔。通过长穿刺器引入超纤细内镜，然后穿过左右膈肌上的硬性切口进入胸腔。在所需的胸腔水平消融神经节。
所有患者均成功完成交感神经切除术。平均手术时间为 68 ± 16 分钟（范围 48-107 分钟）。在任何患者的手术过程中均无死亡，也无转为开放手术。术后中位随访 11 个月（范围 4-12 个月），未观察到膈疝。手掌多汗症和腋窝多汗症的缓解率分别为 100%和 75%。
经脐内镜胸腔交感神经切除术在技术上是可行且安全的，它具有纯 NOTES 的可能优势，并且可以在常规临床实践中进行。
