Department of Pediatric Surgery, Kraków, Poland.
Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
Surg Endosc. 2021 Jul;35(7):3313-3319. doi: 10.1007/s00464-020-07769-0. Epub 2020 Jul 8.
Primary palmar hyperhidrosis is a severely debilitating condition that can affect patients of any age. We report our experience with thoracoscopic sympathicolysis in a large cohort of children less than 14 years of age.
All children who underwent thoracoscopic sympathicolysis from April 2005 through January 2017 were evaluated retrospectively. The procedure entailed bilateral bipolar fulguration of the second and third thoracic ganglia with transverse disruption of collateral nerve fibers along the third and fourth rib. Demographic information, as well as postoperative outcome, complications, and satisfaction were analyzed.
Over the 12 year study interval, a total of 102 children underwent thoracoscopic sympathicolysis for palmar hyperhidrosis. Complete follow-up was available for 98 patients (median age 12 [range 5-14] years; 38 boys [39%]). Median follow-up was 4 [range 2-12] years. Complete palmar dryness was achieved in 93 (95%) cases. One patient suffered postoperative unilateral ptosis, 6 reported gustatory sweating, and 65 experienced compensatory sweating. Average postoperative rating on a 1 (lowest) to 10 (highest) rating scale was 9, with 97 (99%) patients saying that they would undergo the procedure again.
Our technique of thoracoscopic sympathicolysis in children was associated with very high postoperative satisfaction, despite a high rate of compensatory sweating and occasional autonomic gustatory sweating. Other more severe complications in this age group were rare.
原发性手掌多汗症是一种严重影响患者生活的疾病，可发生于任何年龄段。我们报告了对 14 岁以下儿童进行胸腔镜交感神经切断术的经验。
回顾性分析 2005 年 4 月至 2017 年 1 月期间所有接受胸腔镜交感神经切断术的儿童。该手术包括双侧第二和第三胸神经节的双极电灼，并在第三和第四肋骨处横断切断侧支神经纤维。分析了人口统计学信息、术后结果、并发症和满意度。
在 12 年的研究期间，共有 102 名儿童因手掌多汗症接受了胸腔镜交感神经切断术。98 例患者（中位年龄 12 岁[范围 5-14 岁]；38 名男孩[39%]）获得完全随访。中位随访时间为 4 年[范围 2-12 年]。93 例（95%）患者手掌完全干燥。1 例患者术后出现单侧上睑下垂，6 例患者出现味觉性出汗，65 例患者出现代偿性出汗。术后平均评分（1 分最低，10 分最高）为 9 分，97%（99%）的患者表示愿意再次接受该手术。
尽管代偿性出汗和偶尔出现的自主味觉性出汗发生率较高，但我们对儿童胸腔镜交感神经切断术的技术仍取得了非常高的术后满意度。该年龄段其他严重并发症罕见。
