Moon Mi Hyoung, Hyun Kwanyong, Park Jae Kil, Lee Jungsun
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea.
Medicine (Baltimore). 2020 Oct 16;99(42):e22466. doi: 10.1097/MD.0000000000022466.
Compensatory hyperhidrosis is a debilitating postoperative condition occurring in 30% to 90% of patients with primary hyperhidrosis. The most appropriate treatment for compensatory hyperhidrosis remains controversial.Between January 2018 and December 2019, 44 patients with intractable compensatory hyperhidrosis underwent diffuse sympathicotomy (DS). In the early study periods, DS was performed sparsely (limited DS) to avoid possible adverse effects (right R5/7/9/11, left R5/6/8/10). In the late study periods, levels of surgical interruption were further modified to maximize sympatholytic effects (extended DS; bilateral R5/6/7/8/9/10/11). Patients were followed up for symptom resolution. For objective evidence of improved hyperhidrosis, thermographic images were taken for 7 patients.Immediate resolution of compensatory hyperhidrosis was achieved in 81% of patients, as determined at the 1 to 2 week postoperative visit. With a median follow-up of 22.7 months, compensatory hyperhidrosis continued to be resolved in 46% (n = 20). Logistic regression analysis showed that persistent resolution of compensatory hyperhidrosis was independently predicted by extended DS (odds ratio, 25.67, 95% CI, 1.78-1047.6; P = .036). The presence of gender, BMI, isolated compensatory hyperhidrosis, distribution of sweating, prior operation type, reoperation interval, and same-day lumbar sympathectomy failed to gain statistical significance on maintaining persistent resolution of compensatory hyperhidrosis. No patients experienced surgery-related side effects. Thermographic images obtained before/after surgery in 10 patients showed successful denervation and sweat diminishment.This study shows the safeness and effectiveness of DS for treating compensatory hyperhidrosis, representing a new treatment option. Future research should be directed at confirming a promising result of extended DS with further follow-up.
代偿性多汗症是一种令人衰弱的术后病症，在原发性多汗症患者中发生率为30%至90%。代偿性多汗症最恰当的治疗方法仍存在争议。在2018年1月至2019年12月期间，44例顽固性代偿性多汗症患者接受了弥漫性交感神经切断术（DS）。在早期研究阶段，为避免可能的不良反应（右侧R5/7/9/11，左侧R5/6/8/10），DS实施较少（有限DS）。在后期研究阶段，手术切断水平进一步调整以最大化交感神经阻滞效果（扩展DS；双侧R5/6/7/8/9/10/11）。对患者进行随访以观察症状缓解情况。为获得多汗症改善的客观证据，对7例患者进行了热成像检查。术后1至2周的随访显示，81%的患者代偿性多汗症立即得到缓解。中位随访时间为22.7个月时，46%（n = 20）的患者代偿性多汗症仍持续缓解。逻辑回归分析显示，扩展DS可独立预测代偿性多汗症的持续缓解（优势比，25.67，95%可信区间，1.78 - 1047.6；P = 0.036）。性别、体重指数、单纯性代偿性多汗症、出汗分布、既往手术类型、再次手术间隔时间以及同期腰交感神经切除术对代偿性多汗症持续缓解的维持未显示出统计学意义。没有患者出现手术相关的副作用。10例患者术前/术后获得的热成像图像显示去神经支配成功且出汗减少。本研究表明DS治疗代偿性多汗症的安全性和有效性，是一种新的治疗选择。未来研究应通过进一步随访来证实扩展DS的良好效果。
