Jeong Seong Cheol, Kim Jae Jun, Kim In Sub, Kim Yong Hwan, Han Jung Wook, Moon Seok Whan
Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Gyeonggi-do, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2021 Feb;13(2):664-670. doi: 10.21037/jtd-20-2437.
The purpose of this study was to investigate whether performing lower thoracic sympathicotomy (LTS) from T10 to T12 affects plantar hyperhidrosis in patients with palmo-plantar (PP) or palmo-axillary-plantar (PAP) hyperhidrosis.
Between January 2015 and January 2020, all consecutive patients with primary hyperhidrosis who underwent bilateral thoracoscopic sympathicotomy and met the inclusion criteria were included. Sympathicotomy was performed using one of the following two methods: the conventional upper thoracic expanded thoracic sympathicotomy. In the expanded thoracic sympathicotomy, we expanded the level of sympathicotomy ranging from R5 to R12 in addition to the conventional upper thoracic sympathicotomy (R3 or R4). In cases of the expanded thoracic sympathicotomy, we defined the LTS as a sympathicotomy of the levels ranging from R10 to R12, which are related to plantar hyperhidrosis.
A total of 103 subjects with PP (71 cases) or PAP (32 cases) hyperhidrosis were included. Palmar or axillary hyperhidrosis in all patients were alleviated after sympathicotomy. There was no difference in sweating decrease or CH according to the hyperhidrosis types or sympathicotomy techniques. In addition, no-LTS was performed in 77 cases and LTS was performed in 26 cases. In the no-LTS group, there were 65 and 12 cases of low and high degrees of CH, respectively. In the LTS group, there were 22 and four cases of low and high degrees of CH, respectively. There was no significant difference in CH between the no-LTS and LTS groups (P=0.981). Improvement in plantar hyperhidrosis in the no-LTS group was observed in 29 of 77 cases, while improvement in plantar hyperhidrosis in the LTS group was observed in 16 of 26 cases. The addition of LTS lead to significant improvement in plantar hyperhidrosis (P=0.034).
Performing LTS is a safe and feasible procedure that improved plantar sweating more so than it did in cases that did not undergo LTS. Therefore, we cautiously suggest that adding LTS helps in the treatment of plantar hyperhidrosis combined with palmar hyperhidrosis. Further studies on LTS are needed to validate these findings and will be helpful in establishing management guidelines.
本研究旨在调查从T10至T12进行下胸交感神经切断术（LTS）是否会影响掌跖（PP）或掌腋跖（PAP）多汗症患者的足底多汗症。
2015年1月至2020年1月期间，纳入所有连续接受双侧胸腔镜交感神经切断术且符合纳入标准的原发性多汗症患者。交感神经切断术采用以下两种方法之一进行：传统上胸段扩大胸交感神经切断术。在扩大胸交感神经切断术中，除了传统上胸交感神经切断术（R3或R4）外，我们将交感神经切断水平扩大至从R5到R12。在扩大胸交感神经切断术的病例中，我们将LTS定义为与足底多汗症相关的从R10到R12水平的交感神经切断术。
总共纳入了103例PP（71例）或PAP（32例）多汗症患者。交感神经切断术后所有患者的手掌或腋窝多汗症均得到缓解。根据多汗症类型或交感神经切断术技术，出汗减少或代偿性多汗（CH）方面没有差异。此外，77例未进行LTS，26例进行了LTS。在未进行LTS组中，低程度和高程度CH分别有65例和12例。在LTS组中，低程度和高程度CH分别有22例和4例。未进行LTS组和LTS组之间的CH没有显著差异（P = 0.981）。在77例未进行LTS组中，有29例观察到足底多汗症改善，而在26例LTS组中，有16例观察到足底多汗症改善。增加LTS可使足底多汗症得到显著改善（P = 0.034）。
进行LTS是一种安全可行的手术，与未进行LTS的情况相比，能更有效地改善足底出汗。因此，我们谨慎建议增加LTS有助于治疗合并手掌多汗症的足底多汗症。需要对LTS进行进一步研究以验证这些发现，这将有助于制定管理指南。
