Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Sci Rep. 2023 Jan 25;13(1):1402. doi: 10.1038/s41598-023-28727-5.
Thoracic sympathetic nerve block (TSNB) has been widely used in the treatment of neuropathic pain. To reduce block failure rates, TSNB is assisted with several modalities including fluoroscopy, computed tomography, and ultrasonography. The present study describes our experience assessing the usefulness of thoracoscopy in TSNB for predicting compensatory hyperhidrosis before sympathectomy in primary hyperhidrosis. From September 2013 to October 2021, TSNB was performed under local anesthesia using a 2-mm thoracoscope in 302 patients with severe primary hyperhidrosis. Among the 302 patients, 294 were included for analysis. The target level of TSNB was T3 in almost all patients. The mean procedure time was 21 min. Following TSNB, the mean temperature of the left and right palms significantly changed from 31.5 to 35.3 °C and from 31.5 to 34.8 °C, respectively. With TSNB, primary hyperhidrosis was relieved in all patients. Pneumothorax occurred in six patients, in which no chest tube insertion was required. One patient developed hemothorax and was discharged the next day after small-bore catheter drainage. Transient ptosis developed in 10 patients and improved within a day in all patients. Our experiences showed that thoracoscopic TSNB is accurate, safe, and feasible to block the thoracic sympathetic nerve in patients with severe primary hyperhidrosis.
胸交感神经阻滞 (TSNB) 已广泛用于治疗神经性疼痛。为了降低阻滞失败率，TSNB 辅助多种模式，包括透视、计算机断层扫描和超声。本研究描述了我们在原发性多汗症交感神经切除术前评估胸腔镜在 TSNB 中预测代偿性多汗的有用性的经验。从 2013 年 9 月至 2021 年 10 月，在局部麻醉下使用 2mm 胸腔镜对 302 例严重原发性多汗症患者进行 TSNB。在 302 例患者中，有 294 例被纳入分析。TSNB 的目标水平几乎都是 T3。平均手术时间为 21 分钟。TSNB 后，左、右手掌的平均温度从 31.5°C 显著变化至 35.3°C 和从 31.5°C 显著变化至 34.8°C。通过 TSNB，所有患者的原发性多汗症均得到缓解。6 例患者发生气胸，无需插入胸腔引流管。1 例患者发生血胸，经小口径导管引流后次日出院。10 例患者出现短暂性上睑下垂，所有患者均在 1 天内改善。我们的经验表明，胸腔镜 TSNB 对严重原发性多汗症患者准确、安全且可行，可阻断胸交感神经。
