Ibrahim Mohsen, Menna Cecilia, Andreetti Claudio, Ciccone Anna Maria, D'Andrilli Antonio, Maurizi Giulio, Poggi Camilla, Vanni Camilla, Venuta Federico, Rendina Erino Angelo
Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.
Interact Cardiovasc Thorac Surg. 2013 Jun;16(6):834-8. doi: 10.1093/icvts/ivt039. Epub 2013 Feb 26.
Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy.
From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group).
The mean postoperative follow-up period was 12.5 (range: 1-24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome.
Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.
电视辅助胸腔镜交感神经切除术目前是治疗手掌和腋窝多汗症的最佳方法。该手术可通过一期或两期完成。本研究旨在评估两期单侧与一期双侧胸腔镜交感神经切除术的手术及术后效果。
1995年11月至2011年2月，270例重度手掌和/或腋窝多汗症患者纳入本研究。130例患者接受一期双侧单孔电视辅助胸腔镜交感神经切除术（一期组），140例接受两期单侧单孔电视辅助胸腔镜交感神经切除术，两次手术平均间隔时间为4个月（两期组）。
术后平均随访时间为12.5个月（范围：1 - 24个月）。术后所有患者的手部和腋窝均干爽温暖。一期组16例（12%）患者和两期组15例（11%）患者出现轻/中度疼痛（P = 0.8482）。一期组平均手术时间为38±5分钟，两期组为39±8分钟（P = 0.199）。一期组8例（6%）患者和两期组11例（8%）患者发生气胸。一期组25例（19%）患者和两期组6例（4%）患者出现代偿性多汗（P = 0.0001）。无患者发生霍纳综合征。
两期单侧和一期双侧单孔电视辅助胸腔镜交感神经切除术均是有效、安全且微创的手术。两期单侧交感神经切除术可降低代偿性多汗的发生率，永久性改善手掌和腋窝多汗症患者的生活质量。
