de Andrade Filho Laert Oliveira, Kuzniec Sérgio, Wolosker Nelson, Yazbek Guilherme, Kauffman Paulo, Milanez de Campos José Ribas
Division of Thoracic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Ann Vasc Surg. 2013 May;27(4):447-53. doi: 10.1016/j.avsg.2012.05.026. Epub 2013 Feb 11.
The aim of this study was to ascertain the technical difficulties and complications of video-assisted thoracic sympathectomy (VTAS) in the treatment of hyperhidrosis in a large group of patients.
Between October 1995 and February 2008, 1731 patients with palmar, axillary, or craniofacial hyperhidrosis, who were treated using bilateral VTAS, were studied. We assessed the technical difficulties, early and late complications, and the approaches that were used to resolve them.
Therapeutic success was achieved in 91% of the cases as evidenced by anhidrosis. The most common and severe technical difficulty during the procedure was pleural adhesions in 116 cases (6.7%); azygos lobes were seen in 7 patients (0.4%) and apical blebs in 3 patients (0.2%). The most frequent postoperative immediate complication was postoperative pain in 1685 (97.4%) patients; pneumothorax with chest drainage was seen in 60 cases (3.5%), neurologic disorders involving the upper limbs in 36 cases (2.1%), Horner's syndrome in 11 cases (0.9%), significant bleeding in 8 cases (0.4%), and 1 patient had extensive subcutaneous emphysema. The most frequent late complication was compensatory hyperhidrosis, which occurred in 1531 cases (88.4%). Although 27.2% of the patients reported severe compensatory hyperhidrosis, only 2.5% expressed regret for undergoing surgery. Gustatory sweating occurred in 334 patients (19.3%). No deaths occurred in this series.
VTAS is safe and has shown good results. The major complication is compensatory hyperhidrosis and, when severe, the patient may express regret for undergoing surgery. Improvements in instrumentation, adequate training, and careful patient selection may help to reduce the number of drawbacks associated with VTAS.
本研究的目的是确定在一大群患者中，电视辅助胸交感神经切除术（VTAS）治疗多汗症的技术困难和并发症。
对1995年10月至2008年2月间1731例因手掌、腋窝或头面部多汗症接受双侧VTAS治疗的患者进行研究。我们评估了技术困难、早期和晚期并发症以及解决这些问题所采用的方法。
91%的病例治疗成功，表现为无汗。手术中最常见和严重的技术困难是胸膜粘连，共116例（6.7%）；7例（0.4%）患者出现奇叶，3例（0.2%）患者出现肺尖肺大疱。术后最常见的即刻并发症是1685例（97.4%）患者出现术后疼痛；60例（3.5%）患者出现需胸腔引流的气胸，36例（2.1%）患者出现上肢神经功能障碍，11例（0.9%）患者出现霍纳综合征，8例（0.4%）患者出现严重出血，1例患者出现广泛皮下气肿。最常见的晚期并发症是代偿性多汗症，共1531例（88.4%）。尽管27.2%的患者报告有严重的代偿性多汗症，但只有2.5%的患者表示后悔接受手术。334例（19.3%）患者出现味觉性出汗。本系列研究中无死亡病例。
VTAS是安全的，且已显示出良好的效果。主要并发症是代偿性多汗症，严重时患者可能会后悔接受手术。器械的改进、充分的培训和谨慎的患者选择可能有助于减少与VTAS相关的缺点。
