Chen Jianfeng, Du Quan, Lin Min, Lin Jianbo, Li Xu, Lai Fancai, Tu Yuanrong
Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
J Laparoendosc Adv Surg Tech A. 2016 Dec;26(12):958-964. doi: 10.1089/lap.2015.0470. Epub 2016 Aug 24.
Transareolar single-port needlescopic thoracic sympathectomy under intravenous anesthesia without intubation has rarely been attempted in managing primary palmar hyperhidrosis (PPH). The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique.
From May 2012 to May 2015, 168 male patients with severe PPH underwent single-port endoscopic thoracic sympathectomy (ETS) and were randomly allocated to groups A or B. Patients in group A underwent nonintubated transareolar ETS with a 2-mm needle endoscope, while those in group B underwent intubated transaxillary ETS with a 5-mm thoracoscope.
All procedures were performed successfully. 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. Postoperative sore throat occurred in 4 patients in group A and in 32 patients in group B (P < .01). The mean incision length was significantly shorter in group A than in group B. The mean postoperative pain scores were markedly higher in group B than in group A. The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients. The mean cosmetic scores were higher in group A than in group B (P < .01).
Nonintubated transareolar single-port ETS with a needle endoscope is a safe, effective, and minimally invasive therapeutic procedure, which allows a smaller incision with less pain and excellent cosmetic results. This novel procedure can be performed in a routine clinical practice for male patients with severe PPH.
在静脉麻醉且不插管的情况下经乳晕单孔针式胸腔镜胸交感神经切除术在原发性手掌多汗症（PPH）的治疗中很少被尝试。本研究的目的是评估这种微创技术的可行性和安全性。
2012年5月至2015年5月，168例重度PPH男性患者接受了单孔胸腔镜胸交感神经切除术（ETS），并随机分为A组或B组。A组患者采用2毫米针式内镜进行非插管经乳晕ETS，而B组患者采用5毫米胸腔镜进行插管经腋窝ETS。
所有手术均成功完成。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。A组有4例患者出现术后咽痛，B组有32例患者出现术后咽痛（P＜0.01）。A组的平均切口长度明显短于B组。B组的平均术后疼痛评分明显高于A组。非插管患者的平均麻醉费用明显低于插管患者。A组的平均美容评分高于B组（P＜0.01）。
使用针式内镜进行非插管经乳晕单孔ETS是一种安全、有效且微创的治疗方法，切口更小，疼痛更少，美容效果极佳。这种新方法可在常规临床实践中用于治疗重度PPH男性患者。
