Chen Jian-Feng, Lin Min, Chen Ping, Quan Du, Li Xu, Lai Fan-Cai, Tu Yuan-Rong
Departments of *Thoracic Surgery †Anesthesia, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
Surg Laparosc Endosc Percutan Tech. 2016 Aug;26(4):328-33. doi: 10.1097/SLE.0000000000000287.
Conventional endoscopic thoracic sympathectomy (ETS) is usually performed with 5-mm thoracoscope under general anesthesia with endotracheal intubation. Needlescopic thoracic sympathectomy under total intravenous anesthesia without intubation has rarely been attempted. This randomized controlled trial assesses the feasibility and safety of this minimally invasive therapeutic procedure in managing primary palmar hyperhidrosis.
From July 2012 to July 2014, 221 patients with severe primary palmar hyperhidrosis underwent bilateral ETS and were randomly allocated to group A or group B. Patients in group A (n=108) underwent nonintubated ETS using a needle endoscope, whereas those in group B (n=113) underwent traditional transaxillary single-port ETS using a 5-mm thoracoscope.
ETS was successfully performed in all patients. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients (P<0.01). Postoperative sore throat occurred in 37 patients in group B, whereas none of the patients in group A complained about sore throat after surgery (P<0.01). The mean incision length was 5.1±0.1 mm with needle endoscope and 11.0±0.8 mm with traditional thoracoscope (P<0.01). The mean postoperative pain score was 1.1±0.8 in group A and 3.2±0.8 in group B (P<0.01). The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients (P<0.01). Follow-up was 100% completed. The mean cosmetic scores were higher in group A than in group B (P<0.01). Residual pain occurred in 2 patients in group A and in 18 patients in group B (P<0.01).
Nonintubated needlescopic thoracic sympathectomy is a safe, effective, and minimally invasive therapeutic procedure, which has the advantages of a smaller incision with less pain, shorter resuscitation time, and better cosmetic results.
传统的内镜下胸交感神经切除术（ETS）通常在全身麻醉气管插管下使用5毫米胸腔镜进行。在全静脉麻醉且不插管的情况下进行针式胸腔镜胸交感神经切除术很少有人尝试。这项随机对照试验评估了这种微创治疗方法治疗原发性手掌多汗症的可行性和安全性。
2012年7月至2014年7月，221例重度原发性手掌多汗症患者接受双侧ETS，并随机分为A组或B组。A组（n = 108）患者使用针式内镜进行非插管ETS，而B组（n = 113）患者使用5毫米胸腔镜进行传统经腋窝单孔ETS。
所有患者的ETS均成功完成。所有患者术后手掌立即变得干爽温暖。非插管患者的平均复苏时间明显短于插管患者（P<0.01）。B组37例患者术后出现咽痛，而A组患者术后均无咽痛主诉（P<0.01）。针式内镜下平均切口长度为5.1±0.1毫米，传统胸腔镜下为11.0±0.8毫米（P<0.01）。A组术后平均疼痛评分为1.1±0.8，B组为3.2±0.8（P<0.01）。非插管患者的平均麻醉费用明显低于插管患者（P<0.01）。随访完成率为100%。A组的平均美容评分高于B组（P<0.01）。A组2例患者出现残留疼痛，B组18例患者出现残留疼痛（P<0.01）。
非插管针式胸腔镜胸交感神经切除术是一种安全、有效且微创的治疗方法，具有切口小、疼痛轻、复苏时间短和美容效果好等优点。
