Division of Vascular and Endovascular Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2013;68(3):311-5. doi: 10.6061/clinics/2013(03)oa05.
The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter).
From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years).
Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution.
Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.
本研究旨在使用出汗测量仪（VapoMeter）前瞻性、随机、盲法和客观地研究手术对掌跖多汗症患者的足底多汗症在一年时间内的影响。
2007 年 2 月至 2009 年 5 月，40 例合并手掌多汗症和足底多汗症的患者在 T3 或 T4 交感神经节水平接受了电视胸腔镜交感神经切除术（15 名女性和 25 名男性，平均年龄 25 岁）。
术后即刻和一年随访期间，所有患者均无手掌多汗症发作。一年后，35 例（87.5%）患者出现不同程度的代偿性多汗。仅有 2 例（2.5%）患者出现严重代偿性多汗。46.25%的病例足底多汗症有较大的初始改善，随后改善逐渐消退，一年后仅有 30%的病例仍有此改善。病情恶化的患者比例逐渐增加（从 21.25%增加到 47.50%），而病情稳定的患者比例减少（从 32.5%减少到 22.50%）。这种变化与切除水平无关，但交感神经切除术之前足底多汗症的强度较低与更差的演变相关。
行电视胸腔镜交感神经切除术治疗手掌多汗症的手掌多汗症和足底多汗症患者在术后一年的随访中表现出足底多汗症的初始改善良好，随后改善程度降低。因此，仅存在足底多汗症时不应行电视胸腔镜交感神经切除术。
