Department of Surgery, Post-Graduation Program in Surgery and Translational Medicine, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil.
Department of Surgery, Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil.
Ann Med. 2021 Dec;53(1):1216-1226. doi: 10.1080/07853890.2021.1953126.
Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.
To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.
This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.
Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, =47.5%), the symptom control rate was 96% (95% CI = 93-99%, =48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.
This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.
原发性多汗症是一种涉及过度出汗的疾病，会对生活质量产生负面影响。
评估电视辅助胸腔镜胸交感神经切除术（VATS）治疗原发性腋窝多汗症（PAH）的有效性和安全性，并确定哪种水平的神经节切除能提供最佳效果。
这是一项对观察性研究进行系统评价和比例荟萃分析的研究。结果评估了满意度、症状控制、代偿性出汗和并发症。进行了亚组分析，以比较高位和低位交感神经干切除术。
共纳入了 13 项研究，总计 1463 例患者。满意度为 92%（95%可信区间：88-95%，=47.5%），症状控制率为 96%（95%可信区间：93-99%，=48.2%），由于研究之间存在高度异质性，无法评估代偿性出汗的存在。并发症罕见。
本综述表明，VATS 下的胸腔交感神经切除术是治疗 PAH 的一种可行且安全的选择。高位和低位切除之间没有差异。然而，由于证据质量极低，对效果的估计相当不确定。
单纯性腋窝多汗症极大地影响生活质量。只有在临床治疗失败时才应考虑手术。电视辅助胸腔镜下胸交感神经切除术是治疗原发性腋窝多汗症的一种可行且安全的选择。
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