Sinha C K, Kiely Edward
Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Eur J Pediatr Surg. 2013 Dec;23(6):486-9. doi: 10.1055/s-0033-1337117. Epub 2013 Mar 4.
The aim of this study was to find out the outcome of "thoracoscopic sympathectomy" (TS) for palmar hyperhidrosis (PH) in children. To our knowledge, this is the largest experience of TS from the United Kingdom.
All patients who underwent TS for PH during the past 21 years were studied retrospectively.
A total of 85 procedures were done in 44 children. Ratio of female to male was 4:1. Median age at operation was 12.8 years. Types of operations performed were as follows: bilateral T2-T3 sympathectomy in 87% (38/44), bilateral T2-T5 sympathectomy in 9% (4/44), and right-sided thoracoscopic (left-sided done open) in 1% (0.5/44); operation was not possible in 3% (1.5/44) of cases. No chest drains were used. Median postoperative stay was 2 days (range 1 to 5). Median follow-up time was 1.3 years (range 0.2 to 4.7 years). Only problematic patients were followed up for longer. During follow-up, 21% (9/44) developed severe hyperhidrosis of other parts of body. Seven percent (3/44) of patients developed severe axillary hyperhidrosis (AH) and required T4-T5 sympathectomy later on at a median age of 14.4 years (range 11 to 16 years). Another 9% (4/44) patients developed severe plantar hyperhidrosis. Severe hyperhidrosis of the whole body was seen in 5% (2/44) of the patients. Postoperative complications were seen in 47% (21/44) of the patients. They were as follows: postoperative pain (needing > 48 hours hospital stay) in 18% (8/44); transient Horner syndrome in 18% (8/44-right 5, left 3); and recurrence of PH in 11% (5/44) of cases. In the recurrence group, 7% (3/44) were unilateral (right 2, left 1) and 5% (2/44) were bilateral. Redo operations were performed in 11% (5/44) of cases. Median time to redo was 2.6 years (range 8 months to 4.2 years). All three unilateral recurrent patients underwent respective sided redo. In the bilateral recurrence group (2/44), one patient had bilateral redo (remained dry), whereas the other patient underwent only right-sided operation (remained dry), as that sided operation was difficult and so the other side was not tried. FINAL OUTCOMES: The final outcomes were recurrence 3.5% (3/85-right 2, left 1) and technically failed operation 3.5% (3/85-both sides 1, one side 1). Success rate for thoracoscopic sympathetectomy was 93% (79/85) overall.
TS for PH is a safe and feasible operation in children. It is successful in the majority; however, the procedure is not trouble free.
本研究旨在探讨“胸腔镜交感神经切除术”（TS）治疗儿童手掌多汗症（PH）的效果。据我们所知，这是英国关于TS的最大规模经验。
对过去21年中接受TS治疗PH的所有患者进行回顾性研究。
共对44名儿童进行了85次手术。男女比例为4:1。手术时的中位年龄为12.8岁。所施行的手术类型如下：双侧T2 - T3交感神经切除术占87%（38/44），双侧T2 - T5交感神经切除术占9%（4/44），右侧胸腔镜手术（左侧开放手术）占1%（0.5/44）；3%（1.5/44）的病例无法进行手术。未使用胸腔引流管。术后中位住院时间为2天（范围1至5天）。中位随访时间为1.3年（范围0.2至4.7年）。仅对有问题的患者进行了更长时间的随访。随访期间，21%（9/44）的患者身体其他部位出现严重多汗症。7%（3/44）的患者出现严重腋窝多汗症（AH），并在中位年龄14.4岁（范围11至16岁）时需要进行T4 - T5交感神经切除术。另外9%（4/44）的患者出现严重足底多汗症。5%（2/44）的患者出现全身严重多汗症。47%（21/44）的患者出现术后并发症。具体如下：术后疼痛（需要住院超过48小时）占18%（8/44）；短暂性霍纳综合征占18%（8/44 - 右侧5例，左侧3例）；11%（5/44）的病例PH复发。在复发组中，7%（3/44）为单侧复发（右侧2例，左侧1例），5%（2/44）为双侧复发。11%（5/44）的病例进行了再次手术。再次手术的中位时间为2.6年（范围8个月至4.2年）。所有3例单侧复发患者均进行了相应侧别的再次手术。在双侧复发组（2/44）中，1例患者进行了双侧再次手术（保持干爽），而另1例患者仅进行了右侧手术（保持干爽），因为该侧手术困难，所以未尝试另一侧。最终结果：最终结果为复发率3.5%（3/85 - 右侧2例，左侧1例），手术技术失败率3.5%（3/85 - 双侧1例，单侧1例）。胸腔镜交感神经切除术的总体成功率为93%（79/85）。
TS治疗儿童PH是一种安全可行的手术。大多数情况下手术成功；然而，该手术并非毫无问题。
