Departments of General Surgery, University Clinic of Surgery, Medical University of Vienna, Vienna, Austria.
Br J Surg. 2013 Oct;100(11):1471-7. doi: 10.1002/bjs.9275.
The aim of this study was to evaluate long-term results, quality of life, satisfaction and compensatory sweating after endothoracic sympathetic block at T4 (ESB4).
Patients who underwent an ESB4 procedure for palmar or palmoaxillary hyperhidrosis between 2001 and 2008 were included in a prospective study at a university hospital. Questionnaires devised by Keller and Milanez de Campos were applied to evaluate disease-specific quality of life.
A total of 189 patients underwent 374 ESB4 procedures. Of 174 evaluated patients, 54 (31·0 per cent) had palmar and 120 (69·0 per cent) had palmoaxillary hyperhidrosis. Median follow-up was 92 months. In both groups, treatment successfully reduced hyperhidrosis (P < 0·001) and quality of life increased significantly after ESB4 (P < 0·001), remaining stable after 5 years. Overall satisfaction rates decreased owing to the development of compensatory sweating and recurrence during follow-up. Compensatory sweating affected 41 patients (23·6 per cent), and was severe in 11 (6·7 per cent) of 163 patients at 5-year follow-up; eight of these 11 patients had been treated for palmoaxillary sweating. The severity of compensatory sweating did not deteriorate with time. The severe recurrence rate increased to 11·0 per cent during follow-up, and was twice as common in patients treated for palmoaxillary sweating as in those treated for palmar sweating (13·2 versus 6·1 per cent respectively). Nine reoperations (5·2 per cent) were performed for persistent sweating, recurrence or compensatory sweating.
T4 endothoracic sympathetic clip application is safe and effective in patients with upper limb hyperhidrosis, with stable long-term improvements in quality of life.
本研究旨在评估 T4 胸交感神经阻滞（ESB4）治疗手掌或手掌-腋窝多汗症的长期疗效、生活质量、满意度和代偿性出汗情况。
我们对 2001 年至 2008 年间在一家大学医院行 ESB4 治疗的手掌或手掌-腋窝多汗症患者进行了前瞻性研究。采用 Keller 和 Milanez de Campos 制定的问卷评估疾病特异性生活质量。
共 189 例患者接受了 374 次 ESB4 治疗。174 例评估患者中，54 例（31.0%）为手掌多汗症，120 例（69.0%）为手掌-腋窝多汗症。中位随访时间为 92 个月。两组患者的多汗症均得到成功治疗（P<0.001），ESB4 后生活质量均显著提高（P<0.001），且 5 年后仍保持稳定。由于代偿性出汗和随访期间的复发，总体满意度下降。41 例（23.6%）患者出现代偿性出汗，163 例中有 11 例（6.7%）严重，5 年随访时严重程度无恶化。8 例 11 例严重代偿性出汗患者曾接受手掌-腋窝多汗症治疗。代偿性出汗的严重程度随时间无恶化。随访期间严重复发率增至 11.0%，接受手掌-腋窝多汗症治疗的患者比接受手掌多汗症治疗的患者更常见（分别为 13.2%和 6.1%）。9 例（5.2%）患者因持续性出汗、复发或代偿性出汗行再次手术。
T4 胸交感神经夹闭治疗上肢多汗症安全有效，长期生活质量稳定改善。
