Dogru Mustafa Vedat, Sezen Celal Bugra, Girgin Oguz, Cansever Levent, Kocaturk Celalettin Ibrahim, Metin Muzaffer, Dincer Seyyit Ibrahim
Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Thoracic Surgery, Faculty Istinye Medical School, Liv Hospital Ulus, Istanbul, Turkey.
Gen Thorac Cardiovasc Surg. 2020 Mar;68(3):273-279. doi: 10.1007/s11748-019-01210-7. Epub 2019 Sep 21.
The discussions at the surgical levels (sympathectomy levels) about endoscopic thoracic sympathectomy (ETS) method, which is applied in hyperhidrosis treatment in the present day and acknowledged as the golden treatment method, continue. Mainly, most of the studies evaluates postoperative early period results. Our aim in this study is to compare the long-term quality of life depending on the different surgical levels (sympathectomy levels) and evaluate the postoperative complications.
165 patients operated due to palmar hyperhidrosis between January 2012 and July 2017 were evaluated. Sympathectomy was performed either by clipping or cauterization and sympathetic nerves included were T2-4, T3-4, or T3 levels. Data were retrospectively reviewed for complications, factors affecting the postoperative quality of life.
Ninety of the patients were male (54.5%) and 75 (45.5%) were female. The level of ganglion block was T2-T4 in 62 patients (37.6%), T3-T4 in 46 patients (27.9%), and T3 in 57 patients (34.5%). Early complications were observed in 27 patients (16.4%). Compensatory hyperhidrosis (CH) was observed in 62 patients (37.6%). There was a significant difference in the postoperative quality of life according to ETS level (p < 0.001). Patients who underwent T2-T4 sympathectomy had a lower quality of life than patients who underwent isolated T3 or T3-T4 sympathectomy.
Based on our results, we recommend performing lower level resections to increase the long-term quality of life in palmar hyperhidrosis patients. The lower risk of CH and comparable quality of life suggest that T3 sympathectomy is more effective.
目前用于治疗多汗症且被公认为黄金治疗方法的内镜胸交感神经切除术（ETS），其手术层面（交感神经切除层面）的相关讨论仍在继续。主要而言，大多数研究评估的是术后早期结果。本研究的目的是比较不同手术层面（交感神经切除层面）下的长期生活质量，并评估术后并发症。
对2012年1月至2017年7月间因手掌多汗症接受手术的165例患者进行评估。通过夹闭或烧灼术进行交感神经切除术，所涉及的交感神经包括T2 - 4、T3 - 4或T3水平。回顾性分析数据，以了解并发症及影响术后生活质量的因素。
患者中男性90例（54.5%），女性75例（45.5%）。神经节阻断水平为T2 - T4的患者有62例（37.6%），T3 - T4的患者有46例（27.9%），T3的患者有57例（34.5%）。27例患者（16.4%）出现早期并发症。62例患者（37.6%）出现代偿性多汗（CH）。根据ETS水平，术后生活质量存在显著差异（p < 0.001）。接受T2 - T4交感神经切除术的患者生活质量低于接受单独T3或T3 - T4交感神经切除术的患者。
基于我们的研究结果，我们建议进行更低层面的切除术以提高手掌多汗症患者的长期生活质量。CH风险较低且生活质量相当表明T3交感神经切除术更有效。
