Department of Surgery, Yamamoto-Hidehiro Clinic, Tokyo, Japan.
Department of Surgery, Yamamoto-Hidehiro Clinic, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2019 Nov;158(5):1481-1488. doi: 10.1016/j.jtcvs.2019.05.062. Epub 2019 Jun 17.
The main therapeutic method of treatment for local hyperhidrosis is endoscopic thoracic sympathectomy. Generally, resections of the sympathetic trunk or ganglia are performed between the second rib and sixth rib. However, this procedure can result in compensatory sweating, in which excess sweating occurs on the back, chest, and abdomen. Compensatory sweating has been regarded as a thermoregulatory response and thought to be untreatable. This study suggests that compensatory sweating is not a physiologic reaction and is indeed treatable.
Eight patients with severe compensatory sweating were treated by observing blood perfusion of the skin with laser speckle flowgraphy, which determines the sympathetic nerves related to the area of skin with compensatory sweating. When intraoperative monitoring with laser speckle flowgraphy indicated the position of compensatory sweating by electrical stimulation of the sympathetic ganglion, ganglionectomy was performed.
The skin domain that each sympathetic nerve controls was able to be detected by laser speckle flowgraphy. In all patients, compensatory sweating was resolved after interruption of the ganglia or sympathetic nerves related to compensatory sweating.
Our results demonstrate that compensatory sweating is caused by denatured sympathetic nerves influenced by endoscopic thoracic sympathectomy and is not the result of a physiological response. With laser speckle flowgraphy, the sympathetic nerve related to the sweating of various parts of the body could be identified. The treatment of compensatory sweating on the back, chest, and stomach was previously considered to be difficult; however, compensatory sweating is demonstrated to be treatable with this technique.
治疗局部多汗症的主要治疗方法是胸腔镜交感神经切除术。一般情况下，交感干或神经节在第二肋到第六肋之间被切除。然而，这种手术可能会导致代偿性出汗，即在背部、胸部和腹部过度出汗。代偿性出汗被认为是一种体温调节反应，且被认为是无法治疗的。本研究表明，代偿性出汗不是一种生理反应，实际上是可以治疗的。
通过激光散斑血流图观察皮肤的血液灌注来治疗 8 例严重代偿性出汗的患者，激光散斑血流图可确定与代偿性出汗皮肤区域相关的交感神经。当激光散斑血流图通过刺激交感神经节进行术中监测，指示出代偿性出汗的位置时，就对神经节进行切除术。
激光散斑血流图能够检测到每条交感神经控制的皮肤区域。在所有患者中，阻断与代偿性出汗相关的神经节或交感神经后，代偿性出汗均得到缓解。
我们的结果表明，代偿性出汗是由胸腔镜交感神经切除术后变性的交感神经引起的，而不是生理反应的结果。通过激光散斑血流图，可以识别与身体各部位出汗相关的交感神经。过去，背部、胸部和胃部的代偿性出汗被认为难以治疗，但通过这项技术，代偿性出汗是可以治疗的。
