Laje Pablo, Rhodes Kali, Magee Leanne, Klarich Mary Kate
Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Surg. 2017 Feb;52(2):313-316. doi: 10.1016/j.jpedsurg.2016.11.030. Epub 2016 Nov 14.
Present our experience in the surgical treatment of primary focal hyperhidrosis of the hands by thoracoscopic bilateral T3 sympathectomy in pediatric patients.
Retrospective chart review of all patients operated between 2013 and 2015.
We operated and included in the study 28 patients, 22 females and 6 males. Mean age was 14 (6-21) years. All patients had previously tried at least one form of medical therapy with no success. All patients were extensively counseled regarding the potential side effects of the sympathectomy. The operations were done in supine position with the arms extended. All patients were intubated with a double-lumen endotracheal tube for sequential lung isolation. We used a 5-mm port for the scope and a 3-mm port for the instruments, both placed in the axilla. The third rib was identified by fluoroscopy. The sympathectomy was done with monopolar cautery. Mean operative time was 43 (25-71) minutes. No chest tubes were used. The incidence of intraoperative or postoperative complications was zero. All patients were discharged within the first 24 postoperative hours. All patients achieved immediate complete postoperative resolution of the palmar hyperhidrosis, sustained in all cases at a median follow-up of 17 (2-34) months. The mean preoperative quality of life score (based on a multifunctional self-assessment questionnaire) was 41/100, whereas after the operation, it was 92/100. Only 1 patient developed temporary compensatory sweating. All patients were satisfied with the result of the operation.
Thoracoscopic bilateral T3 sympathectomy is a safe and effective treatment for children and adolescents with primary focal hyperhidrosis of the hands who failed medical management and have a very low rate of compensatory sweating.
IV.
介绍我们在小儿患者中通过胸腔镜双侧T3交感神经切除术治疗原发性手部局灶性多汗症的经验。
对2013年至2015年间所有接受手术的患者进行回顾性病历审查。
我们对28例患者进行了手术并纳入研究，其中女性22例，男性6例。平均年龄为14（6 - 21）岁。所有患者此前至少尝试过一种药物治疗但均未成功。所有患者均就交感神经切除术的潜在副作用接受了广泛的咨询。手术在仰卧位、双臂伸展的状态下进行。所有患者均使用双腔气管插管进行序贯性肺隔离。我们使用一个5毫米的端口用于放置胸腔镜，一个3毫米的端口用于放置器械，均置于腋窝处。通过荧光透视确定第三肋骨。使用单极电灼进行交感神经切除术。平均手术时间为43（25 - 71）分钟。未使用胸管。术中或术后并发症发生率为零。所有患者均在术后24小时内出院。所有患者术后手掌多汗症立即完全缓解，在中位随访17（2 - 34）个月时所有病例均持续缓解。术前平均生活质量评分（基于多功能自我评估问卷）为41/100，而术后为92/100。仅1例患者出现暂时性代偿性出汗。所有患者对手术结果均满意。
胸腔镜双侧T3交感神经切除术对于药物治疗失败且代偿性出汗发生率极低的原发性手部局灶性多汗症儿童和青少年是一种安全有效的治疗方法。
IV级
