Lima Sonia O, de Santana Vanessa R, Valido Daisy P, de Andrade Renata L B, Fontes Leticia M, Leite Victor Hugo O, Neto José M, Santos Jéssica M, Varjão Lucas L, Reis Francisco P
Department of Medicine, Universidade Tiradentes, Aracaju, Sergipe, Brazil.
Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil.
J Vasc Surg. 2017 Dec;66(6):1806-1813. doi: 10.1016/j.jvs.2017.05.126.
The objective of this study was to assess the reduction in quality of life (QoL) caused by the persistence of primary plantar hyperhidrosis (PPH) symptoms and the level of satisfaction in PPH patients after retroperitoneoscopic lumbar sympathectomy (RLS). The efficacy, safety, and procedure of bilateral RLS in both sexes are also described in this study.
This is a longitudinal study of consecutive patients who sought specific treatment from a private practitioner for severe PPH as classified on the Hyperhidrosis Disease Severity Scale (HDSS) from October 2005 to October 2014. The patients were asked to report the symptoms of PPH experienced in the immediate preoperative period and to complete a standardized QoL questionnaire developed by de Campos at least 12 months after RLS. Disease outcomes, recurrence of symptoms, and any adverse effects of surgery were evaluated after 30 days and at least 12 months after RLS.
Lumbar sympathectomy was performed 116 times in 58 patients; 30 days after surgery, PPH was resolved in all patients. Three patients (5.2%) reported transient thigh neuralgia, and 19 (32.7%) reported transient paresthesia in the lower limbs. There were no reports of retrograde ejaculation. At a minimum of 12 months after RLS, 49 of the 58 patients had fully and correctly answered the follow-up questionnaire and noted a mild (HDSS 2) to moderate (HDSS 3) increase in pre-existing compensatory sweating. One patient had a PPH relapse within 6 months. Improvement in QoL due to the resolution of PPH was reported in 98% of the 49 patients. None of the operations necessitated a change in the laparotomy approach, and none of the patients died.
RLS is safe and effective for the treatment of severe PPH in both sexes. There were no reports of retrograde ejaculation after resection of L3 and L4 ganglia. There was a mild to moderate increase in compensatory sweating in about half of the patients, but without any regret or dissatisfaction for having undergone the surgery because of a significant improvement in QoL.
本研究旨在评估原发性足底多汗症（PPH）症状持续存在对生活质量（QoL）的降低程度以及逆行腹腔镜下腰交感神经切除术（RLS）后PPH患者的满意度。本研究还描述了双侧RLS在男女两性中的疗效、安全性及手术过程。
这是一项对2005年10月至2014年10月期间因严重PPH（根据多汗症疾病严重程度量表[HDSS]分类）而寻求私人执业医生特定治疗的连续患者进行的纵向研究。患者被要求报告术前即刻经历的PPH症状，并在RLS后至少12个月完成由德坎波斯编制的标准化QoL问卷。在RLS后30天以及至少12个月后评估疾病转归、症状复发情况及手术的任何不良反应。
58例患者接受了116次腰交感神经切除术；术后30天，所有患者的PPH均得到缓解。3例患者（5.2%）报告有短暂性大腿神经痛，19例患者（32.7%）报告有下肢短暂性感觉异常。无逆行射精的报告。在RLS后至少12个月时，58例患者中有49例完整且正确地回答了随访问卷，并指出原有的代偿性出汗有轻度（HDSS 2）至中度（HDSS 3）增加。1例患者在6个月内PPH复发。49例患者中有98%报告因PPH得到缓解，生活质量有所改善。所有手术均无需改变剖腹手术方式，且无患者死亡。
RLS治疗男女严重PPH安全有效。切除L3和L4神经节后无逆行射精的报告。约一半患者的代偿性出汗有轻度至中度增加，但由于生活质量有显著改善，患者对接受手术均无后悔或不满。
