Chen Jianfeng, Lin Jianbo, Tu Yuanrong, Lin Min, Li Xu, Lai Fancai
Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Ann Thorac Cardiovasc Surg. 2016;22(1):12-9. doi: 10.5761/atcs.oa.15-00241. Epub 2015 Sep 29.
Natural orifice transluminal endoscopic surgery (NOTES) has recently become a hot spot in the field of minimally invasive surgery. But, most of the procedures are still in the early stages of development and limited to animal experiments. Transareolar endoscopic surgery could work as a viable intermediate step before thoracic NOTES. Under intravenous anesthesia without endotracheal intubation, transareolar endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been attempted. The objective of this study is to evaluate the feasibility and safety of this novel minimally invasive technique in managing primary palmar hyperhidrosis (PPH).
From June 2012 to July 2014, a total of 58 male patients with severe PPH underwent transareolar ETS by use of a flexible endoscope. Under intravenous anesthesia without endotracheal intubation, a flexible endoscope was introduced through the incision on the edge of the areola into the thoracic cavity. The thoracic sympathetic chain was ablated at the level of the fourth rib.
All procedures were successfully performed with a mean operating time of 33.6 ± 8.3 min. All patients regained consciousness rapidly and none of them complained about sore throat after surgery. There were no operative mortality and conversion to open procedure. The symptoms of all patients disappeared as soon as the sympathetic chain was cut off. Fifty six patients (96.6%) were discharged from the hospital on the first postoperative day. The postoperative complications were minor, and no patients developed Horner's syndrome. At 3 months postoperatively, there was no obvious surgical scar on the chest wall, and none of the patients complained about postoperative pain. Compensatory hyperhidrosis (CH) appeared in 19 patients. No recurrent symptoms were observed in our study. One year follow-up revealed an excellent cosmetic result and degree of satisfaction.
Nonintubated transareolar ETS with a flexible endoscope is a safe, effective and minimally invasive therapeutic procedure, which has the possible advantages of thoracic NOTES and can be performed in routine clinical practice for male PPH patients.
经自然腔道内镜手术（NOTES）近来已成为微创手术领域的一个热点。但是，大多数手术仍处于发展初期且仅限于动物实验。经乳晕内镜手术可作为胸部NOTES之前一个可行的中间步骤。在无气管插管的静脉麻醉下，很少有人尝试使用软性内镜进行经乳晕内镜胸交感神经切除术（ETS）。本研究的目的是评估这种新型微创手术技术治疗原发性手掌多汗症（PPH）的可行性和安全性。
2012年6月至2014年7月，共有58例重度PPH男性患者接受了使用软性内镜的经乳晕ETS。在无气管插管的静脉麻醉下，通过乳晕边缘的切口将软性内镜插入胸腔。在第四肋水平切断胸交感神经链。
所有手术均成功完成，平均手术时间为33.6±8.3分钟。所有患者均迅速恢复意识，术后无一例主诉咽痛。无手术死亡病例，也无中转开胸手术的情况。切断交感神经链后所有患者的症状立即消失。56例患者（96.6%）术后第一天出院。术后并发症轻微，无患者发生霍纳综合征。术后3个月，胸壁无明显手术瘢痕，无患者主诉术后疼痛。19例患者出现代偿性多汗（CH）。本研究中未观察到复发病例。一年随访显示美容效果极佳，满意度高。
使用软性内镜的非插管经乳晕ETS是一种安全、有效且微创的治疗方法，具有胸部NOTES的潜在优势，可在男性PPH患者的常规临床实践中开展。
